A Randomised, Phase 3 Non-inferiority Study of DOR/3TC/TDF Compared to DTG/TAF/FTC in Participants Infected With HIV-1 Starting First-line Antiretroviral Therapy

One of the major concerns, voiced by researchers, clinicians, and participants, is that data is severely limited to inform participants with side effects, or those wanting to avoid these side effects, as to evidence-based alternatives. As a result, there are no evidence-based regimens available for participants who have begun experiencing weight gain as a side effect on treatment or wanting to avoid weight gain on initiation of antiretrovirals which is now an almost routine side effect for women or Black participants.

Switching to efavirenz-based regimens, while plausibly associated with weight mitigation in efavirenz slow-metabolizers, is accompanied by unacceptable metabolic, organ and neuropsychiatric side effects in the slow metabolizers likely to experience weight loss. There is minimal data on weight changes for switches from integrase inhibitors and having evidence-based options would dramatically add to treatment possibilities for participants. There is some evidence that the use of TDF and doravirine may mitigate the weight gain seen with TAF/integrase inhibitors combinations.

Doravirine is a compelling replacement for the integrase inhibitors similarly well tolerated, and with a high resistance barrier and better lipid profile as compared to other drugs in the non-nucleoside reverse-transcriptase inhibitor class14. In a recent network meta-analysis, DOR/3TC/TDF was found to exhibit superiority in virological suppression to traditional first line non-DTG containing regimes with more tolerable side effects, and a decrease in severe adverse events.

The DOR/3TC/TDF combination would be a major step forward for current treatment guidelines if found to be equivalent in terms of virological suppression and showed a meaningful difference in weight gain, as well as in cardiometabolic outcomes. This potentially offers clinicians and high risk participants an evidence-based alternative to TAF/integrase inhibitor combinations.

We propose a head-to-head, non-inferiority, randomized study with DTG/TAF/FTC, against a formulation of DOR/3TC/TDF, in antiretroviral-naïve overweight participants, with differences in viral suppression as the primary end points weight gain and metabolic changes-being secondary endpoints of interest at 48 Weeks.