Optimizing Salvage ART: Real-World Outcomes of Doravirine Plus DTG or BIC in Heavily Treatment-Experienced Persons...

Management of heavily treatment-experienced people living with HIV (HTE-PWH) remains challenging due to long antiretroviral therapy (ART) exposure and limited treatment options. We conducted an observational, real-world-data study on HTE-PWH in active care at the "Victor Babeș" Hospital, Bucharest, receiving doravirine (DOR)-based salvage regimens combined with dolutegravir (DTG) or bictegravir (BIC). Epidemiological, clinical, and laboratory variables were analyzed according to HIV acquisition mode and salvage regimen. Sixty-nine PWH were included; 57.9% male, with a median age of 36 years. Median ART duration before switch was 21.5 years. HIV was acquired parenterally in childhood (PM) in 64.7% cases. Salvage regimens included BIC/FTC/TAF + DOR (50.0%), 3TC/TDF/DOR + DTG (35.2%), and 3TC/DTG + DOR (14.7%). The median nadir CD4 count was 37 cells/µL, and the median viral load at diagnosis was 5.24 log10 copies/mL. Switching was performed for regimen simplification (n = 32) or non-adherence-related virological failure (n = 37). At switch, 53.6% had detectable viremia. Viral suppression was achieved in 68.3% at 6 months and 75.0% at 12 months. Individuals with PM infection were younger and had longer ART exposure than those with heterosexual acquisition. DOR-based salvage regimens combined with DTG or BIC were effective in adherent HTE-PWH, particularly those with extensive ART histories.