Can bictegravir and lenacapavir suppress HIV-1 just as well as my complex current regimen?
If you are living with HIV-1 and currently on a complex multi-tablet regimen, you may be wondering whether a simpler option like bictegravir plus lenacapavir can keep your virus suppressed just as well. A recent phase 3 trial called ARTISTRY-1 directly compared switching to a once-daily bictegravir-lenacapavir single-tablet regimen versus staying on a complex regimen. The answer is encouraging: the bictegravir-lenacapavir combination was non-inferior, meaning it worked just as well at maintaining viral suppression through 48 weeks 57.
What the research says
The ARTISTRY-1 trial enrolled 557 people with HIV-1 who were already virologically suppressed on complex antiretroviral regimens. Participants were randomly assigned to either switch to a once-daily bictegravir (75 mg) plus lenacapavir (50 mg) single-tablet regimen or continue their existing complex regimen. At 48 weeks, the proportion of people with HIV-1 RNA ≥50 copies/mL was similar between groups, meeting the criteria for non-inferiority 57. In the phase 2 portion of the same study, 128 participants were followed for 24 weeks, and only 1 out of 52 people in the bictegravir plus lenacapavir 50 mg group had a viral load ≥50 copies/mL, compared with 0 out of 25 in the complex regimen group 6. CD4 cell counts remained stable in all groups, and no serious adverse events led to study discontinuation through 24 weeks 6. At 48 weeks, both doses of lenacapavir (25 mg and 50 mg) combined with bictegravir were highly effective and well tolerated 7. These results suggest that switching to a simpler bictegravir-lenacapavir regimen is a safe and effective option for people who are suppressed on complex therapy.
What to ask your doctor
- Would I be a good candidate for switching to a bictegravir-lenacapavir single-tablet regimen?
- Are there any potential drug interactions between my current medications and bictegravir or lenacapavir?
- What are the possible side effects of bictegravir-lenacapavir compared with my current regimen?
- How often would I need follow-up blood tests after switching to this simpler regimen?
- If I switch and my viral load becomes detectable, what are the next steps?
This question is drawn from common patient questions about Infectious Disease and answered using cited medical research. We do not provide individualized advice.