Antibiotics Contraindicated with Biktarvy

Mechanism of Interaction and Contraindications

• Rifamycin antibiotics, such as rifampin, rifabutin, and rifapentine, are contraindicated with Biktarvy due to significant drug-drug interactions that can substantially decrease bictegravir concentrations, potentially leading to loss of virologic response and possible resistance development, as recommended by the International Antiviral Society-USA panel 1
• The American College of Physicians and other medical societies imply that rifamycins are potent inducers of both UGT1A1 and CYP3A4 enzymes, which significantly accelerate bictegravir metabolism, resulting in substantially decreased bictegravir plasma concentrations, potentially leading to treatment failure 1

Alternative Antiretroviral Options for Tuberculosis Treatment

• The International Antiviral Society-USA panel recommends dolutegravir (50 mg twice daily) with tenofovir/emtricitabine during treatment for active tuberculosis with rifamycin-containing regimens 1
• The International Antiviral Society-USA panel also recommends efavirenz (600 mg) with tenofovir/emtricitabine as an alternative to Biktarvy for patients requiring rifamycin-based tuberculosis treatment 1
• If a protease inhibitor regimen must be used, the International Antiviral Society-USA panel suggests rifabutin (150 mg) should be substituted for rifampin 1

Other Antibiotics with No Significant Interactions

• The Infectious Diseases Society of America notes that doxycycline has no significant interactions with Biktarvy and can be safely co-administered 3
• The Centers for Disease Control and Prevention imply that macrolide antibiotics, such as azithromycin, have no significant interactions with Biktarvy 3

Important Clinical Considerations

• The International Antiviral Society-USA panel recommends ensuring no gaps in antiretroviral coverage when switching from Biktarvy to alternative regimens for tuberculosis treatment to prevent viral rebound 1
• The World Health Organization suggests that treatment planning for patients with both HIV and tuberculosis should involve both infectious disease and tuberculosis specialists 1
• The International Antiviral Society-USA panel emphasizes the importance of regular monitoring of HIV RNA levels when making any antiretroviral therapy changes 1