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.

Authors

Honghong Yang, Qing Yu, Mei Li, Min Liu

Published in

Frontiers in immunology. Volume 17. Pages 1862837. Epub Jun 09, 2026.

Abstract

To 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.
This 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.
Among 4,613 PLWH with long-term treatment, 1,379 were identified as INRs, yielding a prevalence of 29.9%. A total of 446 INRs consistently on a two-NRTI plus EFV regimen (no prior ART switches) were included (median age 50.0 years; median ART duration 69.5 months), of whom 131 switched to BIC/FTC/TAF and 315 continued EFV-based therapy. Compared with the EFV group, the BIC/FTC/TAF group showed greater CD4 cell increases from switching baseline at weeks 48 (66.0 vs. 29.0 cells/μL, P<0.001), 96 (82.5 vs. 46.0 cells/μL, P=0.001), and 144 (82.5 vs. 43.5 cells/μL, P<0.001). Immune reconstitution rates were higher in the BIC/FTC/TAF group at week 48 (34.4% vs. 24.1%, P=0.027) and week 144 (43.8% vs. 32.8%, P=0.005). The immunological benefit was primarily observed in patients aged ≤50 years. Virological suppression rates remained high in both groups.
INRs remain prevalent among PLWH with long-term treatment in southwestern China. In this observational cohort, switching from long-term EFV-based regimens to BIC/FTC/TAF was associated with greater CD4 cell recovery in virologically suppressed INRs, particularly among patients aged ≤50 years. These findings should be interpreted as exploratory and require confirmation in prospective studies.

PMID:
42344928
Bibliographic data and abstract were imported from PubMed on 25 Jun 2026.

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