Antiretroviral Regimen Recommendations for HLA-B*5701 Positive Patients

Critical Contraindications and Recommendations

Patients who test positive for HLA-B5701 should not be given abacavir under any circumstances (evidence rating AIa), as approximately half of HLA-B5701 positive individuals will experience a potentially life-threatening hypersensitivity reaction to abacavir 1, 2, 3
The American Academy of HIV Medicine recommends that HLA-B*5701 positive patients avoid all abacavir-containing regimens due to the risk of potentially life-threatening hypersensitivity reactions 1, 2
The Centers for Disease Control and Prevention recommends documenting HLA-B*5701 test results prominently in the medical record to prevent future inadvertent abacavir exposure 1, 2

Bictegravir is approved for pediatric patients weighing at least 14 kg as part of a complete regimen for HIV-1 treatment 4
The pediatric formulation of bictegravir/emtricitabine/tenofovir alafenamide (30/120/15mg) is specifically indicated for children weighing 14 kg to less than 25 kg, according to the World Health Organization 4

Integrase strand transfer inhibitor (InSTI)-based regimens are the optimal initial therapy for HIV treatment, with bictegravir being a preferred InSTI due to its high barrier to resistance and low pill burden 4
The National Institutes of Health recommends bictegravir-based regimens as first-line therapy due to their high efficacy and safety profile 4
Tenofovir alafenamide (TAF) results in lower plasma levels of tenofovir and higher intracellular concentration compared to TDF, with similar virologic efficacy, according to the European AIDS Clinical Society 5, 3, 4
TAF has fewer tenofovir-associated toxic effects, including less proximal renal tubular toxicity and smaller reductions in bone mineral density compared to TDF, as recommended by the International AIDS Society 5, 3

The combination of bictegravir with TAF/emtricitabine has shown 92.4% virologic suppression rate at 48 weeks in clinical trials, according to the Infectious Diseases Society of America 6
Bictegravir-based regimens are associated with low pill burden and toxicity, making them a preferred option for HIV-1 treatment, as recommended by the American College of Physicians 4

Abacavir is absolutely contraindicated in HLA-B*5701 positive patients due to the risk of potentially life-threatening hypersensitivity reactions, as warned by the FDA 1, 2, 3
Elvitegravir regimens have a lower barrier to resistance compared to bictegravir and include cobicistat, which results in more drug interactions, according to the European Medicines Agency 1, 2, 7