Supporting long-term HIV treatment success: Real-world durability of B/F/TAF

Advances in antiretroviral therapy (ART) have transformed HIV management, with life expectancy among people living with HIV (PLHIV) now comparable to that of the general population. This makes choosing a durable regimen that can sustain treatment success over the long term increasingly important. Recent real-world evidence highlights the durability of bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF), an integrase strand transfer inhibitor (INSTI)–based three-drug regimen, in both treatment-naïve and treatment-experienced settings.

Factors contributing to treatment durability
While newer INSTI-based regimens generally offer effective virologic sup­pression, treatment persistence differs among regimens and can be influenced by a range of factors, including barrier to resistance, safety and tolerability, adher­ence, and patient-centred considerations. Since ART discontinuation increases the risk of viral rebound, selecting a regimen with beneficial attributes beyond virolog­ic efficacy is crucial to support long-term treatment persistence. [AIDS Res Ther 2026;doi:10.1186/s12981-026-00919- 9; HIV Med 2025;26:1707-1716; J Med Econ 2025;28:1241-1251; J Comp Eff Res 2026;15:e250124]

As a convenient single-tablet regimen, B/F/TAF has demonstrated sustained ef­ficacy, a well-tolerated safety profile, a high resistance barrier, high forgiveness during suboptimal adherence, and fa­vourable patient-reported outcomes. Its durability is illustrated by high treatment persistence and consistent effectiveness across different challenging subgroups in real-world studies. [J Antimicrob Chemo­ther 2025;80:281-291; Curr Med Res Opin 2025;41:1319-1331; J Med Econ 2025;28:1241-1251; J Comp Eff Res 2026;15:e250124]

High real-world persistence
In the OPERA study (n=5,839) con­ducted using data from a US electronic health records database, the virologic effectiveness and discontinuation of B/F/ TAF and dolutegravir/lamivudine (DTG/3TC) were compared among virologi­cally suppressed PLHIV (last viral load <200 copies/mL) who switched to either regimen (median follow-up: B/F/TAF, 16 months; DTG/3TC, 15 months). With similar virologic effectiveness (confirmed virologic failure, 2 vs 3 percent), the B/F/TAF group had a lower rate of discontin­uation than the DTG/3TC group (17 vs 19 percent), as well as fewer treatment-related discontinuations (6 vs 9 percent). These findings showed greater treatment persistence with B/F/TAF vs DTG/3TC despite comparable virologic effectiveness, suggesting that other factors may also play a role in sustaining HIV treat­ment. [HIV Med 2025;26:1707-1716]

High treatment persistence was also observed with B/F/TAF in a large US retrospective analysis (n=29,348) of treatment-experienced PLHIV conducted using US prescription claims and medi­cal history data. In the cohort, 11.4 per­cent of PLHIV underwent a subsequent treatment switch, with B/F/TAF show­ing the lowest switch rate (9.2 percent) among the six evaluated INSTI-based regimens, followed by the other two most commonly used regimens, DTG/3TC at 10.3 percent and cabotegravir + rilpivirine at 17.7 percent. (Figure 1) [J Med Econ 2025;28:1241-1251]

PLHIV receiving B/F/TAF were signifi­cantly less likely to undergo a subsequent treatment switch than those receiving any of the other five evaluated regimens (p<0.001). B/F/TAF also demonstrated the lowest risk of subsequent treatment switch across subgroups who have a higher like­lihood of treatment discontinuation, in­cluding older PLHIV (aged ≥50 years) and those with mental health disorders (MHD) or substance use disorders (SUD).

These results support greater treat­ment persistence with B/F/TAF vs other INSTI-based regimens among treatment-experienced PLHIV, including at-risk subgroups.

Durability in PLHIV with high viral burden
The robustness of B/F/TAF was fur­ther supported by the retrospective KLI­MIK HIV-TR trial (n=2,262), which included both treatment-naïve PLHIV with a high viral burden and treatment-experienced PLHIV. [AIDS Res Ther 2026;doi:10.1186/ s12981-026-00919-9]

In the study, 88.5 percent of treatment-naïve participants had base­line HIV-1 RNA >100,000 copies/mL, and 24.2 percent had >1,000,000 cop­ies/mL. B/F/TAF demonstrated effec­tive virological suppression (HIV-1 RNA <200 copies/mL) in the majority of the co­hort, with 95.6 percent achieving suppres­sion at week 24 and 98.3 percent at week 48, which confirmed its effectiveness even in a population with high baseline viral load. Immune recovery was also notable among treatment-naïve participants, with a medi­an increase in CD4 count of 263 cells/mm³ at week 48.

Among treatment-experienced pa­tients, 92.5 percent had HIV-1 RNA <200 copies/mL before switching to B/F/ TAF. At 48 weeks after switching, virologi­cal suppression rate was 96.5 percent.

In terms of safety and tolerability, non-HDL-cholesterol decreased significantly from baseline at week 48 in both treatment-naïve and treatment-experienced partic­ipants, while total cholesterol/HDL ratios remained comparable. No treatment discontinuations due to drug-related adverse effects were observed, and overall treatment discontinuation rates were low (treatment-naïve, 1.7 percent; treatment-experienced, 2.6 percent).

Durability in vulnerable subgroups
HIV is commonly comorbid with MHD and/or SUD. These conditions may pres­ent medication-related and psychosocial challenges, which can affect long-term treatment persistence and contribute to poor viral suppression and worse out­comes. Given the adherence challenges in PLHIV with MHD/SUD, a treatment that supports sustained viral suppression under suboptimal adherence is essential. With a high resistance barrier, B/F/TAF demonstrated high forgiveness in a pre­vious study of PLHIV with low adherence (<85 percent), with 96 percent maintain­ing virologic suppression vs 90 percent of those receiving DTG plus two nucleoside reverse transcriptase inhibitors at week 48. [J Comp Eff Res 2026;15:e250124; J Anti­microb Chemother 2025;80:281-291]

A retrospective study (n=14,826) assessed nonpersistence (including dis­continuation, switch, add-on, or death) among treatment-experienced PLHIV who switched to or restarted one of the evaluated ART regimens from July 2017 to November 2023. MHD/SUD were present in 36 percent of the co­hort, and 28 percent had suboptimal adherence (proportion of days cov­ered <85 percent). Among both the MHD/SUD and suboptimal-adherence subgroups, 12-month persistence rates were significantly higher for B/F/TAF (80.3 and 78.6 percent, respectively) than for DTG/3TC (76.7 and 70.8 percent, re­spectively), abacavir/DTG/3TC (68.9 and 66.3 percent, respectively), DTG + F/TAF (62.4 and 58.9 percent, respectively), and DTG + F/tenofovir disoproxil fumarate (TDF) (36.7 and 41.9 percent, respective­ly). (Figure 2) The risk of nonpersistence was also lower with B/F/TAF vs the other evaluated regimens in both subgroups.

These results suggested that treatment-experienced PLHIV with MHD/ SUD or suboptimal adherence who re­ceived B/F/TAF were more likely to remain on treatment at 1 year than those receiving other commonly prescribed ARTs.

Conclusion
Rather than focusing solely on vi­rologic efficacy as the goal of HIV man­agement, overall treatment durability is a crucial consideration when selecting an ART regimen to support continued treatment success. Real-world treatment persistence provides a more holistic view of ART performance, reflecting a combi­nation of efficacy, safety, resistance bar­rier, adherence, and patient-centred con­siderations. B/F/TAF demonstrates high real-world treatment persistence across different PLHIV populations, supporting continued treatment and potentially min­imizing the need for treatment changes.

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