Bictegravir/Tenofovir Alafenamide/Emtricitabine (BIC/TAF/FTC) for HIV Post-Exposure Prophylaxis
Yes, BIC/TAF/FTC once daily for 28 days is recommended for post-exposure prophylaxis (PEP) after unknown exposure to HIV through unprotected sex. 1
Recommended PEP Regimen
- BIC/TAF/FTC is a CDC-recommended preferred regimen for adults and adolescents requiring PEP, administered as a single tablet once daily for 28 days 1
- 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 1, 2
- The complete 28-day course is essential for maximum effectiveness 1, 2
Evidence Supporting BIC/TAF/FTC for PEP
- Clinical studies have demonstrated high completion rates (90-96%) with BIC/TAF/FTC PEP regimens 3
- BIC/TAF/FTC has shown significantly higher completion rates compared to earlier PEP regimens, including those containing other integrase strand transfer inhibitors 3
- The most common side effects are mild and include nausea/vomiting (15.4%), fatigue (9.6%), and diarrhea (7.7%), which are less common than with historical PEP regimens 3
Timing and Duration Considerations
- PEP must be initiated within 72 hours of exposure, with earlier initiation (ideally within 1-2 hours) providing better protection 1, 2
- The full 28-day course is required for optimal effectiveness 1
- HIV testing should be performed before initiating PEP and at follow-up intervals (4-6 weeks and 12 weeks after exposure) 2
Advantages of BIC/TAF/FTC
- Available as a fixed-dose combination tablet, making it a complete single-tablet regimen 1
- Once-daily dosing improves adherence compared to multiple-pill or multiple-daily-dose regimens 3
- Can be taken with or without food, increasing flexibility 4
- Demonstrates better tolerability and higher completion rates than older PEP regimens 3
Important Clinical Considerations
- 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 anticipated ongoing HIV exposure risk 2
- For unknown HIV status exposures, the decision to use PEP should be based on the risk assessment of the exposure 5
Common Pitfalls to Avoid
- Mistaking PEP for a single-dose intervention, when it requires a full 28-day course 1
- Delaying initiation beyond 72 hours post-exposure significantly reduces effectiveness 1
- Failing to check for drug interactions, particularly with medications containing polyvalent cations 1
- Not completing the full 28-day course, which is essential for maximum protection 1, 3
BIC/TAF/FTC represents a significant advancement in PEP therapy with its single-tablet, once-daily regimen that has demonstrated high completion rates and better tolerability compared to previous options 3.