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Managing Complex Antiretroviral Regimens, Switch BIC/LEN Commentary
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Comment
February 25, 2026
Mike Saag
Download the PDF
Download the PDF
Download the PDF
Phase 3 Efficacy and Safety of Switch From Complex Regimen to Single-Tablet BIC/LEN in ARTISTRY-1 - (02/26/26)
Switch to BIC + LEN in Virologically Suppressed People With HIV on Complex Regimens: Week 96 Outcomes - (02/23/26)
Phase 3 Efficacy and Safety of Switch From B/F/TAF to Single-Tablet BIC/LEN in ARTISTRY-2 - (02/23/26)
The practice of switching antiretroviral therapy (ART) in people with HIV who have reached and maintained virological suppression is an important component of contemporary HIV care. Advances in ART pharmacology, tolerability, and the expanding availability of simplified, single-tablet regimens have shifted treatment goals beyond viral suppression alone towards long-term safety, durability, adherence optimisation, and improved quality of life.1,2
Overall, however, this study represents a major advance in expanding the options of ART for highly treatment-experienced people with HIV who are struggling to remain on complex regimens. In the case of managing individuals who are highly ART-experienced, the majority would rather switch to a simpler single-tablet ART regimen than continue to fight the battle of adhering to complex, multidrug regimens to maintain their HIV treatment success. Based on the results of Orkin and colleagues' study, many people with HIV and their medical providers could now switch to a new oral single-tablet regimen. Further research comparing oral bictegravir–lenacapavir with other more convenient treatment options, such as long-acting, injectable ART agents, is warranted.
Mimicking real-world scenarios, where the majority of patients who are trying to maintain adherence with their complex, multi-tablet regimens are highly ART-experienced, older, have multiple comorbid conditions, and/or are experiencing some degree of kidney dysfunction, Orkin and colleagues' study evaluated participants with a median HIV treatment duration of 28 years (IQR 22–32) and a median age of 60 years (range 22–84), who were taking a median of three ART pills per day (range 2–11; 218 [39%] of 557 were taking ART medications twice daily), and had on average two or more concomitant medical conditions, including dyslipidaemia (377 [68%]), hypertension (280 [50%]), diabetes or hyperglycaemia (133 [24%]), and/or chronic kidney disease (78 [14%]). However, individuals with hepatitis B co-infection were excluded owing to the absence of a regimen component active against hepatitis B. [you could add entecavir, Jules]
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