• See Also
  1. Integrase Strand Transfer Inhibitor
  2. Anti-Retroviral Therapy
  • Indications
  1. HIV Infection (part of combination therapy)
  • Contraindications
  1. Severe hepatic Impairment (Child-Pugh Class C)
  2. Creatinine Clearance <30 ml/min
  • Mechanism
  1. See Integrase Strand Transfer Inhibitor
  • Medications
  1. Bictegravir
    1. As of 2023, Bictegravir is only available in the U.S. in the combination agent Biktarvy
  2. Biktarvy Combination Agent (InSTI and 2 nRTI agents)
    1. Contents
      1. Bictegravir (BIC) 50 mg Biktarvy
      2. Emtricitabine (FTC) 200 mg
      3. Tenofovir Alafenamide (TAF) 25 mg
    2. Dosing
      1. Take one tablet orally daily with or without food
      2. Test for Hepatitis B before starting Biktarvy
    3. Indications
      1. Stable HIV RNA <50 copies/ml (>3 months) without treatment failures or resistance mutations
    4. Contraindications
      1. Creatinine Clearance <30 ml/min
    5. Drug Interactions
      1. Fewer Drug Interactions than Genoya and no Genetic Testing needed before use
      2. Avoid with high dose NSAIDS (Nephrotoxicity Risk)
      3. Avoid within 2 hours of Antacid salts (Mg, Ca, Al)
  • Drug Interactions
  • Bictegravir
  1. Reduced absorption with Antacid salts (Mg, Ca, Al)
    1. Take 2 hours before or after Bictegravir
  2. OAT2 and MATE1 Transport inhibition by Bictegravir
    1. Avoid Dofetilide (risk of toxic levels)
  3. Avoid drugs that reduce the serum concentrations and effectiveness of Bictegravir (metabolized by CYP3A4)
    1. Avoid Rifampin, Rifabutin, Rifapentine
    2. Avoid St Johns Wort
    3. Consider alternatives to specific antiepileptics
      1. Carbamazepine
      2. Oxcarbazepine
      3. Phenobarbital
      4. Phenytoin
  • Resources
  1. Biktarvy (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=664cb8f0-1f65-441b-b0d9-ba3d798be309
  • References
  1. (2018) Presc Lett, New Drug: Biktarvy Resource #340611