From the Guidelines
Biktarvy (bictegravir/emtricitabine/tenofovir alafenamide) has not been definitively established as a direct cause of new-onset cardiomyopathy. While antiretroviral therapy (ART) medications can occasionally contribute to cardiac complications, Biktarvy specifically has a relatively favorable cardiovascular safety profile compared to older HIV medications, as noted in the 2020 recommendations of the International Antiviral Society-USA panel 1. The etiology of cardiomyopathy in patients taking Biktarvy is more likely multifactorial, potentially involving:
- HIV infection itself (which can cause direct myocardial damage)
- Chronic inflammation
- Immune activation
- Opportunistic infections
- Nutritional deficiencies
- Other comorbidities common in HIV patients Tenofovir alafenamide in Biktarvy has less cardiovascular toxicity than older tenofovir formulations, as it results in lower plasma tenofovir levels and is associated with fewer tenofovir-associated adverse effects, such as proximal renal tubular toxicity and reductions in bone mineral density 1. If a patient on Biktarvy develops cardiomyopathy, clinicians should conduct a comprehensive evaluation including:
- Cardiac imaging
- Laboratory tests for other causes
- Assessment of HIV control Management typically involves standard heart failure therapies while maintaining HIV treatment, possibly with consideration of switching ART regimens if Biktarvy is suspected as a contributor after excluding other causes, as suggested by the 2020 recommendations for simplification to a 2-drug regimen in the setting of viral suppression and without drug resistance 1. Close monitoring of cardiac function and HIV parameters is essential during any treatment modifications.
In evaluating the possibility of myocardial disease, it is essential to consider that most patients with a cardiomyopathy have no identifiable causative factor, but in some patients, the cardiomyopathy is related to a systemic disorder, exposure to a cardiotoxic agent, or the presence of myocardial inflammation or infiltration, as noted in the 2005 ACC/AHA guideline update for the diagnosis and management of chronic heart failure in the adult 1. Endomyocardial biopsy may be helpful in certain cases, such as when the cause of the cardiomyopathy is already suspected because of other supportive data, but it is not indicated in the routine evaluation of cardiomyopathy, as stated in the 2005 ACC/AHA guideline update 1.
Overall, the management of cardiomyopathy in patients taking Biktarvy requires a comprehensive approach, considering the potential multifactorial etiology and the need for close monitoring of cardiac function and HIV parameters during treatment modifications.
From the Research
Etiology of New Onset Cardiomyopathy
There are no research papers provided that directly address the etiology of new onset cardiomyopathy in patients taking Biktarvy (Bictegravir/Emtricitabine/Tenofovir alafenamide).
Related Studies
- Studies 2 and 3 discuss the etiology and treatment of cardiomyopathy, but do not specifically address the relationship between Biktarvy and new onset cardiomyopathy.
- Studies 4, 5, and 6 discuss the efficacy and safety of Biktarvy as an antiretroviral therapy, but do not mention cardiomyopathy as a potential side effect.
Key Findings
- The provided studies do not investigate the etiology of new onset cardiomyopathy in patients taking Biktarvy.
- Studies 2 and 3 provide information on the treatment and management of cardiomyopathy, but do not address the specific question of Biktarvy-induced cardiomyopathy.
- Studies 4, 5, and 6 demonstrate the efficacy and safety of Biktarvy as an antiretroviral therapy, but do not explore its potential relationship with cardiomyopathy.