ArticleAIDS (London, England)2026
Renal outcomes with dolutegravir plus lamivudine versus bictegravir/emtricitabine/tenofovir alafenamide in ART-naive adults with HIV.
Article in AIDS (London, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveDolutegravir plus lamivudine (DTG + 3TC) and bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) are guideline-recommended first-line regimens for people with HIV (PWH), but their comparative renal safety remains unclear. We aimed to compare kidney outcomes between these regimens in antiretroviral therapy (ART)-naive PWH, stratified by baseline renal function.
methodsWe conducted a multicenter, prospective cohort study in China (2018-2025) enrolling 2655 ART-naive PWH initiating DTG + 3TC ( n = 788) or BIC/FTC/TAF ( n = 1867). Participants were stratified by baseline estimated glomerular filtration rate (eGFR; <90 versus ≥90 ml/min/1.73 m 2 ). Stabilized inverse probability of treatment weighting was applied to evaluate incident chronic kidney disease (CKD) and longitudinal eGFR changes over 24 months.
resultsAmong participants with baseline creatinine-based eGFR (eGFRcreat) <90 ml/min/1.73 m 2 , DTG + 3TC was associated with greater declines in eGFRcreat compared with BIC/FTC/TAF at 12 and 24 months. In contrast, no significant differences were observed when kidney function was assessed using the cystatin C-based or creatinine-cystatin C-based equation. In the eGFRcreat ≥90 ml/min/1.73 m 2 stratum, trajectories were comparable. CKD incidence was comparable between regimens in both strata (eGFRcreat <90 ml/min/1.73 m 2 : 29.9% versus 16.8%; ≥90 ml/min/1.73 m 2 : 5.1% versus 4.7%; both P > 0.05), and adjusted Cox models showed no significant difference in CKD risk.
conclusionDTG + 3TC and BIC/FTC/TAF showed comparable renal safety over 24 months among ART-naive PWH. However, when a decline in eGFRcreat is observed during DTG treatment, cystatin C-based assessment may help clarify true kidney function.
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