Doravirine and Islatravir Combination Proves Non-Inferior to B/F/TAF: A New Era for Two-Drug HIV Maintenance

Introduction: The Evolving Landscape of HIV Maintenance

The management of HIV-1 has undergone a paradigm shift over the last decade, moving from complex multi-pill regimens to highly effective single-tablet regimens (STRs). While integrase strand-transfer inhibitor (INSTI)-based therapies, such as the combination of bictegravir, emtricitabine, and tenofovir alafenamide (B/F/TAF), currently represent the gold standard for many patients, the clinical community continues to seek alternative strategies. This pursuit is driven by the need for personalized medicine, the management of long-term metabolic or weight-related side effects associated with some INSTIs, and the desire to minimize cumulative drug exposure through two-drug regimens (2DRs).

The recent Phase 3 trial published in The Lancet by Colson and colleagues provides critical evidence for a novel 2DR consisting of doravirine, a next-generation non-nucleoside reverse transcriptase inhibitor (NNRTI), and islatravir, the first nucleoside reverse transcriptase translocation inhibitor (NRTTI). This study evaluates the efficacy and safety of switching virologically suppressed adults from the robust B/F/TAF regimen to this new fixed-dose combination.