Biktarvy

The recommended dosage for Biktarvy is:

• One tablet (50 mg bictegravir/200 mg emtricitabine/25 mg tenofovir alafenamide) taken orally once daily, with or without food.

This dosage is the same for both adults and pediatric patients who weigh at least 25 kg.

Biktarvy is contraindicated in patients who:

• Have a known hypersensitivity to bictegravir, emtricitabine, tenofovir alafenamide, or any component of the formulation.
• Are taking dofetilide, a medication used to treat certain heart conditions, due to the potential for serious drug interactions.

Patients taking Biktarvy should be advised to:

• Take the medication exactly as prescribed, every day, to maintain an undetectable viral load.
• Inform their healthcare provider of all medications they are taking, including over-the-counter drugs and supplements, as Biktarvy can interact with other medications, including those used to treat tuberculosis, epilepsy, and other conditions.
• Be aware of potential side effects and report any unusual symptoms to their healthcare provider.
• Continue regular follow-ups with their healthcare provider to monitor their HIV status and ensure the medication is working effectively.
• Use additional methods to prevent HIV transmission, such as practicing safe sex and not sharing needles, as Biktarvy does not cure HIV and the virus can still be transmitted to others.

• Headache
• Nausea
• Diarrhea
• Fatigue
• Dizziness

• Lactic acidosis and severe hepatomegaly with steatosis: Though rare, this condition can be life-threatening. Symptoms may include nausea, vomiting, abdominal pain, and rapid breathing.
• Severe exacerbations of hepatitis B: In patients who are co-infected with HIV and HBV (hepatitis B virus), stopping Biktarvy can lead to severe liver problems. Patients with HBV should not discontinue Biktarvy without medical supervision.
• Renal impairment: Tenofovir alafenamide has been associated with renal toxicity. Patients should be monitored for kidney function while taking Biktarvy.

Hepatitis B Co-infection: Patients with HIV who are co-infected with hepatitis B should be carefully monitored if Biktarvy is discontinued, as there is a risk of severe exacerbation of hepatitis B.

Drug Interactions: Biktarvy can interact with several other medications, including rifampin, anticonvulsants, and St. John’s wort, which can reduce the effectiveness of the treatment. It is important to inform healthcare providers of all concurrent medications.

Lactic Acidosis and Hepatomegaly: Though rare, patients should be aware of the risk of lactic acidosis and liver enlargement, especially if they have other risk factors.

Biktarvy can interact with several other medications, including:

• Dofetilide: Contraindicated due to the risk of serious side effects.
• Rifampin: Can decrease the effectiveness of Biktarvy.
• Anticonvulsants: Such as carbamazepine and phenobarbital, can reduce the levels of bictegravir in the blood.
• St. John's Wort: A herbal supplement that can lower the effectiveness of Biktarvy.

Patients should inform their healthcare provider of all medications and supplements they are taking to avoid potential interactions.

Alternative treatments for HIV-1 infection include:

• Other single-tablet regimens: Such as Genvoya, Triumeq, or Dovato, which also combine multiple antiretrovirals into a single daily pill.
• Combination therapy: Using separate medications like dolutegravir plus tenofovir/emtricitabine.
• Other classes of antiretrovirals: Such as protease inhibitors (e.g., darunavir) or non-nucleoside reverse transcriptase inhibitors (e.g., efavirenz), depending on the patient's specific situation.

The choice of treatment depends on factors such as the patient's resistance profile, tolerability, and co-existing conditions.