DOR/TDF/3TC COmpared With BIC/FTC/TAF in ART-Naïve People Living With HIV and Overweight or Obesity

Study Assessments Measurements: Laboratory tests, vital signs, and body composition (via bioimpedance) will be assessed at weeks 4, 12, 24, 36, 48, 72, 96, 120, and 144. HIV viral load and CD4+ count will be measured at weeks 12, 24, 48, 72, 96, 120, and 144.Statistical Methods: Non-probabilistic sampling will be used. Data distribution will be evaluated with the Kolmogorov-Smirnov test. Descriptive statistics (means, medians, percentages) will be reported. Between-group comparisons will use the Mann-Whitney U test for continuous variables and chi-square or Fisher's exact test for categorical variables. Longitudinal analysis at weeks 12, 24, 48, 96, and 144 will employ the Wilcoxon test. A p-value ≤0.05 with a 95% confidence interval will indicate statistical significance.Study ProcedureEligible ART-naïve PWH attending the HIV clinic will be identified and invited to participate. After providing informed consent, participants will be informed that participation is voluntary and can be withdrawn at any time without consequences.

Baseline Visit

* Data Collection: A medical interview will gather sociodemographic, clinical, and comorbidity data, as well as lifestyle habits (diet, physical activity, alcohol use, smoking). * Anthropometric Measurements: Conducted using a 4-point segmental bioimpedance scale (FitScan Segmental Body Composition Monitor C-545F) to assess weight, water percentage, muscle mass, bone mass, and fat percentage. Waist and hip circumference, blood pressure, heart rate, respiratory rate, and oxygen saturation will also be measured. * Laboratory Assessments: Include glucose, creatinine, cystatin C, serum and urinary electrolytes, lipid profile, liver function tests, elastography (visceral and subcutaneous fat), complete blood count, HIV viral load, CD4+ count, hepatitis B and C serologies, and VDRL.

Randomization and Follow-Up Participants will be randomized using the MEDSHARING digital system to either DOR/3TC/TDF or BIC/FTC/TAF. Follow-up visits will occur at specified intervals through week 144. Adverse events will be monitored using the DAIDS grading scale. Neuropsychiatric assessments will use the Hospital Anxiety and Depression Scale (HADS), Insomnia Severity Index (ISI), and Patient Health Questionnaire (PHQ-9). Treatment satisfaction and distress will be evaluated with the HIV Treatment Satisfaction Questionnaire (HIVTSQ) and HIV Symptom Distress Module (HIVSDM).

Sampling and Sample Size

Simple random sampling will be employed. The sample size is 306 participants per group, calculated based on:

* 80% statistical power * Alpha level of 0.05 * 12% non-inferiority margin * 80% expected virologic response at week 48 * 10% attrition rate Statistical Analysis * Categorical Variables: Reported as frequencies and percentages. * Continuous Variables: Described using means ± standard deviations or medians with interquartile ranges. * Statistical Tests:

* Between-group comparisons: Mann-Whitney U or Student's t-test * Within-group comparisons: Wilcoxon or paired t-test * Multiple time points: Friedman or repeated-measures ANOVA * Associations: Chi-square or Fisher's exact test * Multivariate analysis: Binary logistic regression * Software: SPSS v29.0.2 for Mac (IBM) will be used for data analysis. Ethical Considerations and Data Confidentiality The study adheres to the Declaration of Helsinki, CIOMS/WHO, and ICH-GCP guidelines. Approval has been obtained from the institutional Ethics and Research Committee. Participant confidentiality will comply with IMSS policy and Mexican regulations, using anonymized unique codes. Only standard-of-care treatments per national and international guidelines will be used. Risks are minimal, primarily related to venipuncture, with medical evaluation and treatment provided as needed

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