Impact on weight of a Doravirine switch in people living with HIV

Doravirine is among the first-line recommended treatments for people living with HIV (PLHIV) in the 2025 EACS guidelines. As opposed to tenofovir alafenamide or anti-integrase, its use was not associated with weight gain in clinical trials, but limited data are currently available in real life. In this cohort study, we investigated weight variation in PLHIV switching to doravirine.

A retrospective cohort analysis was conducted in two Parisian hospitals, including all PLHIV switching to doravirine between January 2019 and September 2022. Body Mass Index (BMI) variation was calculated from 48 months before to 36 months after the switch.

Between January 2019 and December 2022, 300 patients were included, with 220 men (73%) and 185 (62%) patients born in France. The main antiretroviral combination before the switch was TAF/FTC/BIC (n = 47, 16%), and after the switch, doravirine with TDF and 3TC (n = 202, 67%). Twenty-eight patients (9.3%) discontinued doravirine after a median duration of 17.5 months. At 12 and 24 months after the switch, the median BMI variation was 0.0 kg/m², and this variation remained unchanged regardless of the pre-switch treatment. These results were less pronounced in subgroups of patients originating from sub-Saharan Africa (+0.2 and +0.4 kg/m²) and in women (+0.3 and 0.5 kg/m²).

Switching to doravirine led to a weight stabilisation, without reversal of the previously gained weight. In PLHIV at higher risk of weight gain, there was still a slight increase in BMI after the doravirine switch.