Objective:

To evaluate the impact of switching to a two-drug regimen (Dovato) versus a three-drug regimen (Biktarvy) on the incidence of steatotic liver disease (SLD) in virologically suppressed adults living with HIV-1, highlighting the significance of metabolic health in HIV treatment.

Key Findings:

• SLD was reported in 49% of BIC/FTC/TAF recipients versus 29% of DTG/3TC recipients (p=0.033).
• In participants with ≥5% weight gain, SLD occurred in 76% on BIC/FTC/TAF versus 17% on DTG/3TC (p=0.002).
• No significant differences in SLD were observed in participants who gained less than 5% of baseline body weight.

Interpretation:

Switching to Dovato (DTG/3TC) is associated with a lower incidence of steatotic liver disease compared to Biktarvy (BIC/FTC/TAF), particularly in individuals experiencing significant weight gain, which has important implications for clinical practice.

Limitations:

• The study focused on a specific subgroup of participants, which may limit generalizability and introduce potential biases.
• Long-term effects beyond 96 weeks were not assessed.

Conclusion:

The findings suggest that Dovato may offer metabolic advantages, including lower rates of liver steatosis, which is crucial for long-term HIV management.