Same-Day Switch from Dovato to Biktarvy
Yes, a patient can be switched from Dovato (dolutegravir/lamivudine) to Biktarvy (bictegravir/emtricitabine/tenofovir alafenamide) on the same day, provided the patient is virologically suppressed and has no documented resistance to integrase inhibitors or NRTIs. 1
Prerequisites Before Switching
Before executing a same-day switch, you must verify the following:
- Confirmed viral suppression with HIV-1 RNA <50 copies/mL on the current Dovato regimen 1
- Complete antiretroviral treatment history review to identify any prior virologic failures or resistance testing results 2, 1
- No documented NRTI or integrase inhibitor resistance mutations, as these would contraindicate the switch 1
- Hepatitis B co-infection screening, since both regimens contain active HBV agents (though Biktarvy contains tenofovir alafenamide and emtricitabine while Dovato does not contain tenofovir) 1
- Renal function assessment (eGFR) to ensure appropriateness of the tenofovir alafenamide formulation 1
Clinical Rationale for This Switch
The switch from Dovato to Biktarvy is supported by guideline recommendations for switching virologically suppressed patients to recommended initial regimens like Biktarvy, provided virologic suppression can be maintained 1. Valid clinical reasons include:
- Drug-drug interaction concerns that may arise with future medications 1
- Patient preference for a different regimen 1
- Hepatitis B co-infection, as Biktarvy provides dual HBV activity with tenofovir alafenamide and emtricitabine, whereas Dovato only contains lamivudine 1, 3
- Renal or bone protection, as switching from non-tenofovir regimens to tenofovir alafenamide-based regimens is supported when appropriate 2
Evidence Supporting Same-Day Switching
The 2018 International Antiviral Society-USA guidelines explicitly support switching from various suppressive regimens to single-tablet regimens including bictegravir/emtricitabine/tenofovir alafenamide 2. The guidelines state that switching to bictegravir/emtricitabine/tenofovir alafenamide maintained viral suppression above 90% when switching from boosted protease inhibitors or from emtricitabine/tenofovir alafenamide plus dolutegravir 2.
Recent high-quality research demonstrates that switching between integrase inhibitor-based regimens maintains excellent virologic suppression. A 2024 study showed that switching from dolutegravir-based therapy to bictegravir/emtricitabine/tenofovir alafenamide maintained virologic suppression rates of 99.5% at 96 weeks with no treatment-emergent resistance 4. Additionally, a 2018 phase 3 trial demonstrated that switching to bictegravir/emtricitabine/tenofovir alafenamide from dolutegravir/abacavir/lamivudine was non-inferior, with only 1% experiencing virologic failure 5.
Post-Switch Monitoring Protocol
After executing the same-day switch, implement the following monitoring schedule:
- Check HIV-1 RNA at 1 month post-switch to confirm maintained viral suppression 1, 6
- Monitor viral load every 3 months for the first year, then at least every 6 months if stable 1
- Assess renal function (serum creatinine, eGFR) at baseline and periodically, particularly given the tenofovir alafenamide content 1
- Provide adherence counseling at the time of switch to ensure understanding of the new regimen 1
Common Pitfalls to Avoid
Do not switch if there is any documented integrase inhibitor or NRTI resistance, as both regimens rely on these drug classes 1. The high genetic barrier to resistance of both bictegravir and dolutegravir does not overcome pre-existing resistance mutations 3.
Do not overlook hepatitis B co-infection status—if the patient has HBV and you're switching from Dovato (which only contains lamivudine for HBV), Biktarvy provides superior HBV suppression with dual agents 1, 3. Conversely, if switching in the opposite direction, you would risk HBV flare.
Review all concomitant medications before switching, though bictegravir has fewer drug-drug interactions than boosted regimens, certain interactions still exist 1, 3.