Two or Three? Clinical and Proteomic Perspectives on Dolutegravir/Lamivudine Versus Bictegravir/ Emtricitabine/Tenofovir Alafenamide as Initial HIV Treatment

Abstract

While triple-drug regimens (3DR) have long been the standard of care for HIV infection, two-drug regimens (2DR), particularly dolutegravir/lamivudine (DTG/3TC), have emerged as viable first-line options. However, there is limited understanding of how baseline clinical profiles associated with regimen choice relate to underlying inflammatory states and long-term immune trajectories. Regimen selection was associated with baseline disease severity and inflammatory burden. Despite being used in patients with more advanced profiles, BIC/F/TAF effectively reduced systemic inflammation over 2 years. Both regimens attenuated inflammatory activity, though with distinct trajectories that may carry implications for immune recovery and long-term outcomes.