Doravirine Regimen Reduces Weight Gain in Initial HIV Care

Managing HIV therapy weight gain presents a significant challenge for clinicians treating adults starting antiretroviral therapy. Modern regimens containing integrase inhibitors often cause substantial body weight accumulation over time. However, recent data from the Opti-DOR trial offers a promising alternative approach. Specifically, researchers compared a doravirine-based treatment against standard dolutegravir-based therapy.

Evaluating HIV Therapy Weight Gain in the Opti-DOR Study

The open-label trial evaluated six hundred treatment-naive adult patients across South Africa. One group received a once-daily combination of doravirine, lamivudine, and tenofovir disoproxil fumarate. Meanwhile, the second group received dolutegravir, emtricitabine, and tenofovir alafenamide. Primary endpoints focused on achieving viral suppression below fifty copies per milliliter at week forty-eight.

Efficacy and Cardiometabolic Outcomes

Notably, the doravirine regimen achieved noninferior viral suppression compared to the standard regimen. Approximately eighty-nine percent of patients in the doravirine group attained full viral control. Similarly, ninety-point-seven percent of patients in the dolutegravir arm reached viral suppression. Furthermore, participants on the doravirine combination experienced significantly lower median weight accumulation. Consequently, clinicians can consider this option to minimize long-term cardiometabolic risk in at-risk populations.

Frequently Asked Questions

Q1: What is the main benefit of the doravirine regimen in HIV care?

The doravirine-based regimen maintains high viral suppression while producing significantly less weight gain compared to dolutegravir combinations.

Q2: How effective was doravirine compared to dolutegravir at 48 weeks?

Doravirine achieved noninferior viral suppression, with eighty-nine percent of participants reaching undetected viral loads.

Q3: Why is weight gain management critical during initial HIV therapy?

Excessive weight gain increases long-term risks of cardiovascular disease, hypertension, and diabetes in patients living with HIV.

References

1. Woods J et al. Initial HIV Therapy for Adults and Treatment-Associated Weight Gain: The Opti-DOR Randomized Clinical Trial. JAMA. 2026 Jul 31. doi: 10.1001/jama.2026.14762. PMID: 42536019.
2. MedPage Today. ART Regimen Effective, Led to Less Weight Gain in Treatment-Naive HIV. 2026.
3. Wits University. Another HIV treatment option – but with less weight-gain. 2026.