10/10 🙏

Huge thanks to all participants, investigators, and INSTINCT/GESIDA10918 study sites.

Funded by Gilead/GESIDA (ISR-17-10294).
#HIV #HIVResearch #INSTINCT #ClinicalTrials #InfectiousDiseases

9/10 📚

Together with studies like SALSA, TANGO, iPrEx, and DISCOVER, INSTINCT reinforces that:

🔸 TDF has weight/lipid-suppressive effects
🔸 TAF shows no independent effects on weight
🔸 Modern regimens have comparable metabolic profiles

But results to date have not been uniform (PASODOBLE).

8/10 💭
As noted in the accompanying editorial by @JohnKoethe in the same CID issue: the discussion has evolved from "TAF promotes weight" → "TDF suppresses weight" → "TAF is neutral"
Our data support this latest conclusion.
doi.org/10.1093/cid/...

7/10 🔍

Why does this matter? For years, there was debate whether TAF had "obesogenic" properties when compared to TDF.

This study:

✅ Isolates TAF's effect (adding it to a 2-drug regimen) ✅ Eliminates confounders (no simultaneous changes in other ARVs)

6/10 🦠

Virologic efficacy: Maintained in >95% of participants in both groups. No differences in viral suppression or rebounds.

Safety: Well tolerated, mild and balanced adverse events.

5/10 💊
Metabolic profile: Minimal and similar changes in:
• Total cholesterol
• LDL/HDL
• Triglycerides
• Renal function (eGFR)

4/10 ⚖️

Weight: This is crucial. Annualized weight change:
• BIC/FTC/TAF: +0.3%
• DTG/3TC: +0.2%
No significant difference (p=0.895). Only 23% vs 17% gained ≥5% weight (p=NS).

3/10 📊

Inflammation 🔥: No significant differences in any inflammatory biomarker (sCD14, IL-6, D-dimer, sCD163, hsCRP, Kyn/Trp ratio) between groups over 96 weeks.

2/10 🎯

Design: 141 participants with virologic suppression on stable DTG/3TC were randomized 1:1 to:
• Continue DTG/3TC
• Switch to BIC/FTC/TAF
Follow-up: 96 weeks

Hypothesis: Could "intensification" to 3 drugs reduce residual inflammation and metabolic parameters?

Thanks to the organizers, assistants, international speakers and sponsors to keep alive this crucial event for the #HPV community in Spain 🤗

Beautiful research, thank you!🎉🎊

📣 HIV responses can’t hinge on political shifts.
✊🏾 We need stable, committed funding—not abandonment.🧪
#PEPFAR #HIV #FundingCrisis #GlobalHealth #IAS2025