A New HIV Regimen Delivers Equally Strong Viral Control…

A New HIV Regimen Delivers Equally Strong Viral Control, With Significantly Less Weight Gain Weight gain has become an increasingly recognised downside of modern HIV treatment, particularly with the most widely used first line regimens. A major new randomised trial published in JAMA offers the first direct, head to head comparison specifically designed to address this problem. Second generation integrase inhibitor based regimens, particularly those combining dolutegravir or bictegravir with tenofovir alafenamide, have become the global standard for starting HIV treatment, valued for their potency and high barrier to resistance. More than 23 million people worldwide currently receive dolutegravir containing regimens. However, substantial evidence has shown these regimens are also associated with significant weight gain, most pronounced in the first one to two years of treatment, and disproportionately affecting women, Black populations, and people with more advanced HIV disease at treatment start. Critically, once this weight gain occurs, switching to a different regimen later doesn't appear to reverse it, meaning prevention from the very start of treatment may be far more achievable than correction afterward. Researchers conducted this trial across two South African sites, one urban, one rural, enrolling 600 adults starting HIV treatment for the first time. Participants were randomly assigned to receive either a newer combination, doravirine, lamivudine, and tenofovir disoproxil fumarate, or the standard combination, dolutegravir, emtricitabine,