Comparative analysis of lipid profile changes in treatment-naïve people living with HIV on INSTI-based single-tablet regimens, BIC/FTC/TAF and DTG/3TC: real-world evidence from South Korea

BACKGROUND: Advances in antiretroviral therapy (ART) have shifted the focus of HIV management towards metabolic comorbidities such as atherosclerotic cardiovascular disease (ASCVD). However, real-world data comparing lipid profile changes, key determinants of ASCVD, between bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) and dolutegravir/lamivudine (DTG/3TC) remain limited. METHODS: A retrospective cohort study was conducted using medical records from the National Medical Center, Seoul, South Korea, from January 2012 to March 2024. Lipid profiles were analysed over 2 years following initiation of BIC/FTC/TAF or DTG/3TC in treatment-naïve people living with HIV (PLH). Individuals receiving lipid-lowering agents and a previous history of ASCVD were excluded. People with hepatitis B and/or C virus infection were included, and infection status was adjusted for as a covariate along with alanine aminotransferase and aspartate aminotransferase. A linear mixed model was applied to compare lipid profiles between the different ART regimens over time. RESULTS: A total of 194 treatment-naïve PLH were included in the final analysis: 137 (70.6%) initiated BIC/FTC/TAF and 57 (29.4%) initiated DTG/3TC. Over 2 years, longitudinal analysis showed that PLH receiving DTG/3TC had significantly smaller LDL cholesterol increases over time compared to BIC/FTC/TAF (ART-by-time interaction: β = -8.03, P = 0.035). The TC/HDL-C ratio showed a trend towards improvement in the DTG/3TC group (β = -0.19, P = 0.094). Triglyceride levels remained stable with no significant ART-by-time interaction (β = 17.60, P = 0.271). CONCLUSIONS: DTG/3TC demonstrated more favourable lipid changes than BIC/FTC/TAF in treatment-naïve individuals, with significantly smaller LDL cholesterol increases and a trend towards an improved TC/HDL ratio over time. These findings may be informative during the ART selection especially for PLH with cardiovascular risk factors.