Quality of life among older adults with HIV after switching to bictegravir-based three-drug or dolutegravir-based two-drug regimens.

BACKGROUND: Data on adults aged ≥60 years with HIV remain limited, despite their increasing representation in clinical practice. We evaluated whether age ≥60 years was associated with reasons for treatment switch, quality of life (QoL) and clinical outcomes among adults with HIV switching antiretroviral therapy in routine care. METHODS: We performed a cross-sectional analysis of prospectively collected data from a real-world cohort established in 2018, including adults with HIV aged ≥50 years who switched to bictegravir-based three-drug regimens (BIC 3DR) or dolutegravir-based two-drug regimens (DTG 2DR). Participants were stratified by age (≥60 vs. <60 years). Outcomes included reasons for treatment switch, incident comorbidity and self-reported QoL. QoL was analysed as both ordinal and dichotomous (favourable vs. non-favourable). Multivariable analyses were adjusted for treatment strategy, sex and HIV acquisition route. RESULTS: The distribution of reasons for treatment switch differed by age within the DTG 2DR group (p = 0.005), but not within the BIC 3DR group. In the DTG 2DR group, toxicity or adverse events accounted for 5.6% of switches among participants aged <60 years and 21.7% among those aged ≥60 years (p = 0.008), with a significant age-group-by-treatment-strategy interaction (p = 0.001). Age ≥60 years was independently associated with higher odds of favourable QoL (adjusted odds ratio [OR] 2.88, 95% confidence interval [CI] 1.15-7.24), with no interaction by treatment. No significant differences were observed in incident hypertension, type 2 diabetes mellitus or dyslipidemia in time-to-event analyses. CONCLUSIONS: Among adults with HIV switching antiretroviral therapy, age ≥60 years was associated with differences in the distribution of reasons for treatment switch and with better perceived QoL, but not with differences in clinical outcomes.