Real-world persistence of bictegravir versus dolutegravir single-tablet regimens: A retrospective cohort study in a large urban Canadian HIV clinic

Background Single-tablet regimens (STRs) with integrase inhibitors, bictegravir (BIC) or dolutegravir (DTG), are favored in HIV treatment for their efficacy and convenience. This study compares persistence—time from initiation to discontinuation—between BIC/emtricitabine (FTC)/tenofovir alafenamide (TAF) and DTG-containing STRs at a Toronto HIV clinic . Methods A retrospective cohort analysis was conducted on 1732 adults with HIV at Maple Leaf Medical Clinic who initiated or switched to BIC/FTC/TAF or DTG-containing STRs from 2016 to 2022. Persistence was measured in days until discontinuation. Kaplan-Meier curves and Cox models evaluated time-to-discontinuation and associated risks. Reasons for discontinuation were categorized into adverse events, patient preference, cost, compliance, physician preference, virologic failure, and others. Results Among 1732 participants (median age 48 years, 88.7% cisgender men), 387 (22.3%) discontinued their STRs after a median of 402 days. BIC/FTC/TAF had a lower discontinuation rate (18.9%) compared to DTG-containing STRs (29.9%) (HR = 0.74, 95% CI: 0.60–0.92). Adverse events were the primary reason for discontinuation, with BIC having lower rates (9.6% vs. 12.5% for DTG). Discussion BIC/FTC/TAF demonstrated higher persistence and fewer adverse events than DTG-containing STRs, aiding personalized HIV treatment decisions for better long-term outcomes.