[Comment] Managing complex antiretroviral regimens

Managing complex antiretroviral regimens Affiliations & Notes Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL 35294, USA Article Info Publication History: Published February 25, 2026 DOI: 10.1016/S0140-6736(26)00364-8 External LinkAlso available on ScienceDirect External Link Copyright: © 2026 Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies. Linked Articles Download started OkThe practice of switching antiretroviral therapy (ART) in people with HIV who have reached and maintained virological suppression is an important component of contemporary HIV care. Advances in ART pharmacology, tolerability, and the expanding availability of simplified, single-tablet regimens have shifted treatment goals beyond viral suppression alone towards long-term safety, durability, adherence optimisation, and improved quality of life.1,2 References 1. Panel on Antiretroviral Guidelines for Adults and Adolescents Guidelines for the use of antiretroviral agents in adults and adolescents with HIV. Department of Health and Human Services https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/adult-adolescent-arv/guidelines-adult-adolescent-arv.pdf Date accessed: February 16, 2026 2. Gandhi, RT ∙ Landovitz, RJ ∙ Sax, PE ∙ et al. Antiretroviral drugs for treatment and prevention of HIV infection in adults: 2024 recommendations of the International Antiviral Society–USA Panel JAMA. 2025; 333:609-628 3. Orkin, C ∙ Ruane, PJ ∙ Hedgcock, M ∙ et al. Switch to single-tablet bictegravir–lenacapavir from a complex HIV regimen (ARTISTRY-1): a randomised, open-label, phase 3 clinical trial Lancet. 2026; published online Feb 25. https://doi.org/10.1016/S0140-6736(26)00307-7 4. Llibre, JM ∙ Hung, CC ∙ Brinson, C ∙ et al. Phase III SWORD 1 & 2: switch to dolutegravir plus rilpivirine maintains virologic suppression Lancet. 2018; 391:839-849 5. van Wyk, J ∙ Ajana, F ∙ Bisshop, F ∙ et al. Efficacy and safety of switching to dolutegravir/lamivudine fixed-dose 2-drug regimen vs continuing a tenofovir alafenamide-based 3- or 4-drug regimen for maintenance of virologic suppression in adults living with human immunodeficiency virus type 1: phase 3, randomized, noninferiority TANGO study Clin Infect Dis. 2020; 71:1920-1929 6. Overton, ET ∙ Richmond, G ∙ Rizzardini, G ∙ et al. Long-acting cabotegravir and rilpivirine dosed every 2 months in adults with HIV-1 infection (ATLAS-2M), 48-week results: a randomised, multicentre, open-label, phase 3b, non-inferiority study Lancet. 2021; 396:1994-2005 7. Sax, PE ∙ Rockstroh, JK ∙ Luetkemeyer, AF ∙ et al., the GS-US-380–4030 Investigators Switching to bictegravir, emtricitabine, and tenofovir alafenamide in virologically suppressed adults with human immunodeficiency virus Clin Infect Dis. 2021; 73:e485-e493 8. Daar, ES ∙ DeJesus, E ∙ Ruane, P ∙ et al. Efficacy and safety of switching to fixed-dose bictegravir, emtricitabine, and tenofovir alafenamide from boosted protease inhibitor-based regimens in virologically suppressed adults with HIV-1: 48 week results of a randomised, open-label, multicentre, phase 3, non-inferiority trial Lancet HIV. 2018; 5:e347-e356 9. Colson, AE ∙ Mills, AM ∙ Ramgopal, MN ∙ et al. Switch to fixed-dose doravirine (100 mg) and islatravir (0·25 mg) once daily in virologically suppressed adults with HIV-1 on bictegravir, emtricitabine, and tenofovir alafenamide: 48-week results of a phase 3, multicentre, randomised, controlled, double-blind, non-inferiority trial Lancet. 2026; 407:611-621 10. Orkin, C ∙ Arasteh, K ∙ Górgolas Hernández-Mora, M ∙ et al. Long-acting cabotegravir and rilpivirine after oral induction for HIV-1 infection N Engl J Med. 2020; 382:1124-1135