BIC/FTC/TAF (Bictegravir/Emtricitabine/Tenofovir Alafenamide) for HIV Post-Exposure Prophylaxis
No, BIC/FTC/TAF is not a one-time dose for HIV post-exposure prophylaxis (PEP), but rather must be taken once daily for a full 28-day course. 1, 2
Recommended Dosing Regimen
- BIC/FTC/TAF is administered as a single tablet once daily for 28 days for complete HIV post-exposure prophylaxis 1
- The regimen is classified as a preferred regimen by the CDC for adults and adolescents requiring PEP 1, 2
- BIC/FTC/TAF is available as a fixed-dose combination (FDC) tablet, making it a complete single-tablet regimen 1
Evidence Supporting BIC/FTC/TAF for PEP
- Clinical studies have demonstrated high completion rates (90-96%) with BIC/FTC/TAF PEP regimens 1, 3, 4
- BIC/FTC/TAF has shown significantly higher completion rates compared to earlier PEP regimens including:
- Zidovudine/lamivudine plus a protease inhibitor (38.8%)
- Twice daily raltegravir plus TDF/FTC (57.0%)
- Co-formulated elvitegravir/cobicistat/TDF/FTC (71.0%) 1
- No HIV seroconversions were observed in clinical studies evaluating BIC/FTC/TAF for PEP 3, 4
Advantages of BIC/FTC/TAF Over Other PEP Regimens
- Once-daily dosing improves adherence compared to multi-tablet or twice-daily regimens 1, 5
- Lower incidence of side effects compared to historical PEP regimens 3
- Most common side effects are mild and include nausea/vomiting (15.4%), fatigue (9.6%), and diarrhea (7.7%) 3
- Premature discontinuation due to adverse events is rare 3, 4
Important Clinical Considerations
- PEP should be initiated as soon as possible after exposure, preferably within 1-2 hours, but can be started up to 72 hours post-exposure 2
- HIV testing should be performed before initiating PEP and at follow-up intervals (4-6 weeks and 12 weeks after exposure) 2
- PEP can be discontinued if the source is found to be HIV-negative at any point during the course 2
- Consider transition from PEP to PrEP after completion of the 28-day PEP course for individuals with ongoing HIV exposure risk 2
Special Populations
- BIC/FTC/TAF is recommended as a preferred regimen for children aged ≥2 years and weighing ≥14 kg 1
- For pregnant women, dolutegravir with TAF/FTC is the recommended ART regimen 6
- For infants and children under 2 years, different regimens are recommended based on age and weight 1
Common Pitfalls to Avoid
- Mistaking PEP for a single-dose intervention (it requires full 28-day course) 1
- Poor adherence leading to reduced effectiveness (emphasize importance of completing full course) 1, 3
- Delaying initiation beyond 72 hours post-exposure (reduces effectiveness) 2
- Failing to check for drug interactions, particularly with medications containing polyvalent cations (aluminum, calcium, iron, magnesium) 6