Bictegravir with emtricitabine and tenofovir alafenamide

How it works

Bictegravir blocks integration of viral DNA into the host genome, while emtricitabine and tenofovir alafenamide are incorporated by reverse transcriptase to terminate the growing viral DNA chain.

Prescribing in practice

• All patients should be tested for hepatitis B before starting, as stopping the emtricitabine and tenofovir components can cause severe hepatitis B flares requiring monitoring after discontinuation.
• Polyvalent-cation antacids and supplements impair bictegravir absorption and must be separated in time or taken with food as directed in the SPC.
• It is not recommended in significant renal impairment below the licensed threshold and certain anticonvulsants and rifamycins reduce bictegravir exposure.

Monitoring

Monitor renal function and, where indicated, hepatitis B status, alongside HIV viral load and CD4 response.

Counselling the patient

• Take one tablet once daily and never run out, as missed doses risk resistance.
• Separate this from indigestion remedies, calcium, magnesium or iron, or take with food as advised.
• Do not stop this medicine without specialist advice, especially if you have hepatitis B.

Evidence & guidelines

Efficacy and tolerability were established in the GS-US-380 phase 3 programme supporting its use as first-line therapy.