Same-Day Switch from Dovato to Biktarvy

Prerequisites Before Switching

The American College of Physicians recommends confirmed viral suppression with HIV-1 RNA <50 copies/mL on the current Dovato regimen before switching to Biktarvy 1
A complete antiretroviral treatment history review is necessary to identify any prior virologic failures or resistance testing results, as recommended by the International Antiviral Society-USA 2, 1
The presence of no documented NRTI or integrase inhibitor resistance mutations is a prerequisite for switching, as stated by the Praxis Medical Insights 1
Hepatitis B co-infection screening is required, as both regimens contain active HBV agents, according to the Praxis Medical Insights 1
Renal function assessment (eGFR) is necessary to ensure appropriateness of the tenofovir alafenamide formulation, as recommended by the Praxis Medical Insights 1

The International Antiviral Society-USA guidelines support switching virologically suppressed patients to recommended initial regimens like Biktarvy, provided virologic suppression can be maintained, with a strength of evidence rated as high 1
Valid clinical reasons for switching include drug-drug interaction concerns that may arise with future medications, as stated by the Praxis Medical Insights 1
Patient preference for a different regimen is a valid reason for switching, according to the Praxis Medical Insights 1
The presence of hepatitis B co-infection is a valid reason for switching, as Biktarvy provides dual HBV activity with tenofovir alafenamide and emtricitabine, whereas Dovato only contains lamivudine, as stated by the Praxis Medical Insights 1
Renal or bone protection is a valid reason for switching, as switching from non-tenofovir regimens to tenofovir alafenamide-based regimens is supported when appropriate, according to the JAMA 2

The 2018 International Antiviral Society-USA guidelines explicitly support switching from various suppressive regimens to single-tablet regimens including bictegravir/emtricitabine/tenofovir alafenamide, with a strength of evidence rated as high 3
Switching to bictegravir/emtricitabine/tenofovir alafenamide maintained viral suppression above 90% when switching from boosted protease inhibitors or from emtricitabine/tenofovir alafenamide plus dolutegravir, as stated by the JAMA 3

The Praxis Medical Insights recommends checking HIV-1 RNA at 1 month post-switch to confirm maintained viral suppression, with a strength of evidence rated as moderate 1, 4
Monitoring viral load every 3 months for the first year, then at least every 6 months if stable, is recommended by the Praxis Medical Insights 1
Assessing renal function (serum creatinine, eGFR) at baseline and periodically, particularly given the tenofovir alafenamide content, is recommended by the Praxis Medical Insights 1
Providing adherence counseling at the time of switch to ensure understanding of the new regimen is recommended by the Praxis Medical Insights 1

The Praxis Medical Insights warns against switching if there is any documented integrase inhibitor or NRTI resistance, as both regimens rely on these drug classes, with a strength of evidence rated as high 1
Overlooking hepatitis B co-infection status is a common pitfall to avoid, as Biktarvy provides superior HBV suppression with dual agents, according to the Praxis Medical Insights 1
Reviewing all concomitant medications before switching is necessary, though bictegravir has fewer drug-drug interactions than boosted regimens, certain interactions still exist, as stated by the Praxis Medical Insights 1