Switching from Genvoya to Biktarvy

Prerequisites and Considerations

The International Antiviral Society-USA recommends switching virologically suppressed patients from older regimens to recommended initial regimens like Biktarvy, provided virologic suppression can be maintained, and the patient has no documented resistance to integrase inhibitors or NRTIs 1, 2
Patients must have confirmed viral suppression status with HIV-1 RNA <50 copies/mL on the current Genvoya regimen, and a review of their complete antiretroviral treatment history must be conducted to identify any prior virologic failures or resistance testing results 3
It is essential to assess for documented NRTI or integrase inhibitor resistance mutations, as these would contraindicate the switch, according to the American College of Physicians 1, 2, 3
Screening for hepatitis B co-infection is necessary, as both regimens contain tenofovir alafenamide and emtricitabine, which maintain HBV suppression, as recommended by the Centers for Disease Control and Prevention 3
Evaluation of renal function (eGFR) is required to ensure the appropriateness of the tenofovir alafenamide formulation, as suggested by the National Kidney Foundation 3

The switch from Genvoya to Biktarvy is advantageous due to the reduced potential for drug-drug interactions with bictegravir compared to cobicistat-boosted regimens, as noted by the American College of Cardiology 1
The transition maintains the same NRTI backbone and once-daily dosing, preserving adherence patterns, according to the International Antiviral Society-USA 3
Valid clinical rationales for switching from Genvoya to Biktarvy include drug-drug interactions with cobicistat, patient preference for a regimen without pharmacokinetic boosting, anticipated medication additions that interact with cobicistat, and simplification to a regimen with fewer interaction concerns, as recommended by the American Academy of HIV Medicine 1, 2, 4, 5

After executing the same-day switch, it is recommended to check HIV-1 RNA at 1 month post-switch to confirm maintained viral suppression, and monitor every 3 months for the first year, then at least every 6 months if stable, as suggested by the Infectious Diseases Society of America 3
Assessment of renal function (serum creatinine, eGFR) at baseline and periodically is necessary, particularly given tenofovir alafenamide content, according to the National Institute of Diabetes and Digestive and Kidney Diseases 3
Providing adherence counseling at the time of switch is crucial to ensure understanding of the new regimen, as recommended by the Health Resources and Services Administration 3