Factors influencing antiretroviral therapy switching in people with virologically suppressed HIV-1: a cross-sectional multicenter study in France.

Introduction: In France, over 90% of people living with HIV-1 (PLWH) achieve virological suppression with effective combination of antiretroviral therapies (ART), but limited data exist on the motivation for switching ART.

Objective: To describe the reasons and determinants for switching ART, with a particular focus on doravirine-based regimens, in routine clinical practice in France.

Design: This analysis of cross-sectional baseline data is part of the DoraVIH study, a French, multicenter (15 sites), two-step observational cohort study that includes prospective follow-up for a subset of participants.

Methods: Eligible participants were PLWH under ART regimen, virologically suppressed for at least 6-months, doravirine-naïve and switching ART regimen. Sociodemographic and clinical data, ART history, and reasons for switching ART were assessed at baseline.

Results: Inclusions occurred between December 13, 2021 and September 21, 2022. Of the 291 PLWH included whose data were analyzed, 143 switched to doravirine-based regimen (DOR PLWH) and 148 to another combined regimen (non-DOR PLWH). Mean age was 51.6 years and 206 participants (70.8%) were men. At baseline, 35 (25.0%) DOR PLWH and 15 (10.6%) non-DOR PLWH had Body Mass Index (BMI) ≥30 kg/m2 (p = 0.007). The most common reasons for switching were treatment simplification, tolerability and drug-drug interactions, accounting for 79.7% of all reasons. Among the 68 participants with prior tolerability issues, 47 (69.1%) switched to doravirine-based regimen.

Conclusions: Primary reasons for switch were treatment simplification and tolerability. Participants with obesity were more likely to switch to doravirine, reflecting physicians' favorable perception of doravirine potential benefits, particularly in managing weight gain.