Should bictegravir (BIC)/emtricitabine (FTC)/tenofovir alafenamide (TAF) be taken before or after a meal?

Bictegravir/Emtricitabine/Tenofovir Alafenamide (BIC/FTC/TAF) Administration

BIC/FTC/TAF can be taken with or without food—there is no requirement to take it before or after meals. 1, 2, 3

Dosing Flexibility

• The standard dose is one tablet taken orally once daily, and food intake does not affect administration 1, 2, 3
• This flexibility distinguishes BIC/FTC/TAF from elvitegravir-based regimens, which must be taken with food 1
• The FDA label explicitly states the medication should be taken "once daily with or without food" for all approved populations 3

Pharmacokinetic Evidence

• When comparing high-fat meals to fasting states, bictegravir shows an AUC ratio of 1.24 and Cmax ratio of 1.13, indicating food increases absorption slightly but this is not clinically significant 3
• Tenofovir alafenamide demonstrates an AUC ratio of 1.63 with high-fat meals, but the medication remains effective regardless of food intake 3
• The drug maintains therapeutic levels and efficacy whether taken with or without food, as demonstrated in multiple clinical trials 1, 4, 5

Important Clinical Context

• This food-independent administration applies to all approved uses: HIV treatment, post-exposure prophylaxis (PEP), and in special populations including adolescents and children weighing ≥14 kg 6, 3, 5
• The only exception is for transgender women using 2-1-1 on-demand PrEP dosing with TDF/FTC (not BIC/FTC/TAF), where food is recommended to optimize rectal tissue drug concentrations 7

Common Pitfall to Avoid

• Do not confuse BIC/FTC/TAF with elvitegravir/cobicistat/FTC/TAF, which requires food for adequate absorption 1
• Patients switching from elvitegravir-based regimens should be counseled that the food requirement no longer applies with BIC/FTC/TAF 1