Immune recovery following switch from EFV-based regimens to bictegravir/emtricitabine/tenofovir alafenamide in virologically suppressed immunological non-responders: a 144-week real-world cohort study in China

ObjectiveTo investigate the prevalence of immunological non-responders (INRs) among people living with HIV (PLWH) administered long-term antiretroviral therapy (ART) in Chongqing, China, and to evaluate whether switching from an efavirenz (EFV)-based regimen to bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) was associated with immune recovery in INR patients.MethodsThis retrospective real-world cohort study was conducted at Chongqing Public Health Medical Center. PLWH administered continuous two-nucleoside reverse transcriptase inhibitors (NRTIs) plus EFV therapy for ≥4 years, who achieved sustained viral suppression (HIV RNA <50 copies/mL) but maintained CD4 cell counts <350 cells/μL were defined as INRs according to Chinese guidelines.

PLWH were grouped according to whether they continued EFV-based therapy (EFV group) or switched to BIC/FTC/TAF between January and December 2022. Changes in CD4 cell counts, CD4/CD8 ratios, immune reconstitution rates, and virological suppression were assessed at weeks 48, 96, and 144.ResultsAmong 4,613 PLWH with long-term treatment, 1,379 were identified as INRs, yielding a prevalence of 29.9%.