{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T04:06:07Z","timestamp":1784261167646,"version":"3.55.0"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2025,6,27]],"date-time":"2025-06-27T00:00:00Z","timestamp":1750982400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100032626","name":"UNITAID","doi-asserted-by":"crossref","award":["2016-09-UNSW"],"award-info":[{"award-number":["2016-09-UNSW"]}],"id":[{"id":"10.13039\/100032626","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["18Q065"],"award-info":[{"award-number":["18Q065"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["19Q120"],"award-info":[{"award-number":["19Q120"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"name":"National Health and Medical Research Council, Australia","award":["APP1104610"],"award-info":[{"award-number":["APP1104610"]}]},{"DOI":"10.13039\/100010877","name":"ViiV Healthcare","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010877","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008897","name":"Janssen Pharmaceutica","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008897","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Longer-term outcome data following second-line antiretroviral therapy initiation in resource-limited settings is limited, especially in regions where genotypic resistance is inaccessible. This analysis evaluated extended efficacy and tolerability data from the D2EFT study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>D2EFT is a completed, multicenter, phase IIIB\/IV, randomized, open-label trial in 14 low- and middle-income countries. People with human immunodeficiency virus (HIV) who had failed first-line non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimens were switched to 1 of ritonavir-boosted darunavir plus 2 nucleoside reverse transcriptase inhibitors (DRV\/r + 2NRTIs), ritonavir-boosted darunavir plus dolutegravir (DTG + DRV\/r), or dolutegravir with tenofovir disoproxil fumarate plus either lamivudine or emtricitabine (DTG + TDF\/XTC), with or without pre-switch genotyping. Here we report virological suppression at 96 weeks, defined as HIV RNA &amp;lt;50\u2005copies\/mL in a modified intention-to-treat population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Between November 2017 and January 2022, 1190 participants were screened, 828 were randomized, and 826 were included in the analysis. At week 96, the proportions of participants with HIV RNA &amp;lt;50\u2005copies\/mL were 191\/251 (76.1%) in DRV\/r + 2NRTIs, 215\/251 (85.7%) in DTG + DRV\/r, and 231\/283 (81.6%) in DTG + TDF\/XTC. The treatment differences (95% confidence intervals [CIs]) in proportions achieving virological suppression were 9.6% (2.7, 16.4) in DTG + DRV\/r and 9.0% (1.4, 16.6) in DTG + TDF\/XTC, compared to DRV\/r + 2NRTIs. Intermediate or high-level dolutegravir resistance was identified in 3\/27 (13%) of virological failures in individuals taking DTG + TDF\/XTC but in no one taking DTG + DRV\/r. No darunavir resistance was observed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>After 96 weeks of follow-up, DTG + DRV\/r and DTG + TDF\/XTC demonstrated virological superiority over DRV\/r + 2NRTIs after first-line NNRTI-failure. However, emerging dolutegravir resistance, which was observed only in individuals taking DTG + TDF\/XTC, requires ongoing global surveillance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciaf346","type":"journal-article","created":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T07:50:55Z","timestamp":1750924255000},"page":"e568-e580","source":"Crossref","is-referenced-by-count":2,"title":["A Randomized Trial to Compare Dolutegravir Plus Boosted Darunavir Versus Recommended Standard of Care Antiretroviral Regimens in People With HIV-1, Whose First-line Non-nucleoside Reverse Transcriptase Inhibitor Therapy Has Failed: Final 96-week Results of the D2EFT Study"],"prefix":"10.1093","volume":"81","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-6470-8548","authenticated-orcid":false,"given":"Phyo Pyae","family":"Nyein","sequence":"first","affiliation":[{"name":"The Kirby Institute, University of New South Wales , Sydney 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