Quality of life among older adults with HIV after switching to bictegravir‐based three‐drug or dolutegravir‐based two‐drug regimens

Background Data on adults aged ≥60 years with HIV remain limited, despite their increasing representation in clinical practice. We evaluated whether age ≥60 years was associated with reasons for treatment switch, quality of life (QoL) and clinical outcomes among adults with HIV switching antiretroviral therapy in routine care. Methods We performed a cross‐sectional analysis of prospectively collected data from a real‐world cohort established in 2018, including adults with HIV aged ≥50 years who switched to bictegravir‐based three‐drug regimens (BIC 3DR) or dolutegravir‐based two‐drug regimens (DTG 2DR). Participants were stratified by age (≥60 vs. <60 years). Outcomes included reasons for treatment switch, incident comorbidity and self‐reported QoL. QoL was analysed as both ordinal and dichotomous (favourable vs. non‐favourable). Multivariable analyses were adjusted for treatment strategy, sex and HIV acquisition route. Results The distribution of reasons for treatment switch differed by age within the DTG 2DR group ( p = 0.005), but not within the BIC 3DR group. In the DTG 2DR group, toxicity or adverse events accounted for 5.6% of switches among participants aged <60 years and 21.7% among those aged ≥60 years ( p = 0.008), with a significant age‐group‐by‐treatment‐strategy interaction ( p = 0.001). Age ≥60 years was independently associated with higher odds of favourable QoL (adjusted odds ratio [OR] 2.88, 95% confidence interval [CI] 1.15–7.24), with no interaction by treatment. No significant differences were observed in incident hypertension, type 2 diabetes mellitus or dyslipidemia in time‐to‐event analyses. Conclusions Among adults with HIV switching antiretroviral therapy, age ≥60 years was associated with differences in the distribution of reasons for treatment switch and with better perceived QoL, but not with differences in clinical outcomes.