Switching from etravirine to doravirine in virologically suppressed people with HIV: results from the French multicentre SWEED observational study

BACKGROUND: Doravirine, the most recent NNRTI, may advantageously replace etravirine in virally suppressed PWH. We evaluated the tolerance and efficacy of doravirine-based ART following a switch from etravirine-based ART. METHODS: SWEED is a national, multicentre, retrospective, observational study including adults with HIV-1 and plasma viral load (pVL) <50 copies/mL on etravirine-based ART, who switched to doravirine-based ART (same number of associated drugs) from 09/01/2019 in 10 French hospitals. The primary outcome was virological failure (VF: confirmed pVL ≥50 copies/mL or single pVL ≥50 with ART change) at week 48 (W48). Secondary outcomes included rates of strategy success (pVL <50 copies/mL with no ART change) and treatment discontinuations due to side effects, and changes in CD4 counts and weight. RESULTS: Among 109 participants (79% men; median age 59 years), median ART duration was 25 years, with 13 years of sustained viral suppression. Prior NNRTI failure was documented in 41% of participants, and 46% had resistance mutations to at least one NNRTI. ART consisted of 2-drug (53%) and 3-drug (42%) combinations. Median follow-up was 30 months. One VF occurred by W48 (0.9%, 95%CI: 0.0-5.0); viral suppression was regained without ART change. Four patients discontinued doravirine-based ART due to adverse events; strategy success rate was 91.7% (95% CI: 84.9-96.2) at W48. No significant changes in CD4 counts and weight were observed. CONCLUSION: Doravirine-based ART maintained virological suppression in PWH switching from etravirine-based ART, even in presence of prior NNRTI resistance. Its once-daily dosing, favourable safety profile, and minimal drug interactions support its use in long-term ART strategies.