Switching to doravirine maintains viral suppression in HIV-1

In patients with HIV-1 infection, switching from etravirine-containing antiretroviral therapy (ART) to doravirine-containing ART maintained viral control with 91.7% success rate at 48 weeks and demonstrated good tolerability even in patients with prior resistance to nonnucleoside reverse transcriptase inhibitors (NNRTIs).

METHODOLOGY:

• In a retrospective study at 10 hospitals in France, researchers evaluated whether switching from an etravirine-containing ART regimen to one containing doravirine — a next-generation NNRTI — was associated with a sustained virologic suppression in patients with HIV-1 infection.
• They included 109 adults with HIV-1 infection (median age, 59 years; 79% men) who had a plasma viral load (pVL) below 50 copies/mL for at least 12 months at the time of switching to doravirine-based ART.
• The primary outcome was the rate of virologic failure at week 48, defined as either a confirmed pVL of 50 or more copies/mL or a single pVL of 50 copies/mL associated with a change in ART.
• Secondary outcomes included the rate of strategy success at week 48 (defined as pVL of less than 50 copies/mL with no change in ART), treatment discontinuations due to adverse events, and changes in body weight and CD4 count over the median follow-up period of 30 months.

TAKEAWAY:

• Of the 84% of participants with resistance genotypes, 46% had at least one NNRTI-associated resistance mutation.
• At week 48, the rate of virologic failure was 0.9% (95% CI, 0.0%-5.0%), with only one case occurring by week 48.
• The strategy success rate reached 91.7% (95% CI, 84.9%-96.2%) at week 48, with four treatment discontinuations due to adverse events before week 48.
• No significant changes in body weight or CD4 count were observed.

IN PRACTICE:

“Doravirine demonstrates strong efficacy in patients with long-term ART exposure. Its once-daily dosing, favorable safety profile, and minimal potential for drug-drug interactions make it a compelling option for aging PWH [people with HIV],” the authors wrote.

SOURCE:

This study was led by Romain Palich, Pitié-Salpêtrière Hospital, Paris, France. It was published online on November 04, 2025, in the Journal of Antimicrobial Chemotherapy.

LIMITATIONS:

This study’s retrospective, observational design introduced potential selection and confounding biases. Data were limited to routine clinical records, which may have been incomplete or heterogeneous. The modest sample size reduced the statistical power to detect rare events or examine subgroup differences. Finally, the cohort comprised predominantly older adults and man, limiting the study’s generalizability to younger or more diverse populations.

DISCLOSURES:

This study was funded by MSD France. Several authors reported receiving travel grants and advisory fees from various pharmaceutical companies including Gilead, ViiV Healthcare, Merck, Pfizer, and Moderna.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

Edited by Mandeep Singh Rawat