Standard Dose of Biktarvy for HIV-1 Treatment
The standard dose of Biktarvy (bictegravir, emtricitabine, and tenofovir alafenamide) for the treatment of HIV-1 infection is one tablet containing bictegravir 50 mg, emtricitabine 200 mg, and tenofovir alafenamide 25 mg, taken orally once daily with or without food. 1
Dosing Considerations
- Biktarvy is a complete single-tablet regimen that does not require additional antiretroviral agents for HIV-1 treatment 1
- The medication can be taken with or without food, providing flexibility for patients 1
- No dose adjustment is required when transitioning from other antiretroviral regimens, as demonstrated in clinical trials showing successful switching from boosted protease inhibitor regimens 2
- Biktarvy maintains high efficacy with once-daily dosing, with studies showing viral suppression rates of 84% at 96 weeks 3
Special Population Considerations
Pediatric Dosing
- For children and adolescents weighing ≥25 kg: The adult dose of bictegravir 50 mg, emtricitabine 200 mg, and tenofovir alafenamide 25 mg once daily 4
- For children weighing 14 kg to <25 kg: A reduced strength formulation containing bictegravir 30 mg, emtricitabine 120 mg, and tenofovir alafenamide 15 mg once daily 5
Renal Considerations
- Biktarvy can be used in patients with creatinine clearance ≥30 mL/min 6
- It is the first non-pharmacologically boosted, integrase strand transfer inhibitor (INSTI)-based, triple-combination single-tablet regimen suitable for patients with creatinine clearance 30-50 mL/min 6
Drug Interaction Considerations
- Biktarvy has relatively few drug interactions compared to other antiretroviral regimens 1
- Important interaction to note: Cannot be used with rifampin, which is a significant consideration for patients requiring tuberculosis treatment 1
- For patients with latent tuberculosis infection receiving once-weekly isoniazid and rifapentine (3HP), data suggest that bictegravir-containing regimens might be considered if dolutegravir-containing regimens cannot be used 1
- For patients with active tuberculosis on rifampin-containing regimens, limited data suggest twice-daily dosing of BIC/TAF/FTC may maintain viral suppression 1
Clinical Efficacy
- Biktarvy demonstrated non-inferiority to dolutegravir-based regimens in treatment-naïve adults through 96 weeks of treatment 3
- In treatment-experienced patients, switching to Biktarvy was non-inferior to continuing boosted protease inhibitor regimens, with 98% of patients maintaining viral suppression at 48 weeks 2
- No treatment-emergent resistance to any components of Biktarvy was observed in clinical trials, indicating a high barrier to resistance 3, 6
Common Pitfalls to Avoid
- Failing to screen for hepatitis B virus (HBV) before initiating Biktarvy, as the medication contains components active against HBV (tenofovir alafenamide and emtricitabine) 6
- Not considering potential drug interactions, particularly with medications containing polyvalent cations (calcium, iron, magnesium, aluminum) which can reduce bictegravir absorption 1
- Confusing Biktarvy dosing with other integrase inhibitor regimens that may require twice-daily dosing or food requirements 1
Biktarvy's once-daily single-tablet regimen with minimal food requirements and few drug interactions makes it a convenient and effective option for both treatment-naïve and treatment-experienced patients with HIV-1 infection.