Switching from Biktarvy to Apretude: Timing and Considerations

Proper Switching Protocol

The American College of Cardiology is not mentioned, however, a thorough review of the patient's ART history, prior resistance testing, comorbidities, potential drug interactions, and presence of hepatitis B coinfection is mandatory before making any treatment changes, as recommended by clinical guidelines 1, 2
For patients switching from Biktarvy to injectable cabotegravir (Apretude), the long half-life of cabotegravir requires proper transition to prevent development of resistance, with a recommended approach to maintain the oral regimen (Biktarvy) while initiating the new treatment protocol for Apretude 1

HIV viral load assessment is recommended 1 month after switching regimens to ensure virologic suppression has been maintained, with a strength of evidence based on clinical trials 2, 3
For patients with chronic hepatitis B virus (HBV) coinfection, switching from Biktarvy to Apretude requires continuation of HBV treatment, as Apretude does not provide treatment for or protection against HBV infection, according to clinical guidelines 3, 4
Patients with documented or suspected resistance to cabotegravir should not be switched to Apretude due to increased risk of treatment failure, based on evidence from clinical trials 3

Clinical trials have shown a 1-2% incidence of virologic failure with emergence of 2-class resistance even with adherence to scheduled injections, with risk factors including rilpivirine-associated resistance at baseline, viral subtype A6, and body mass index greater than 30 3

Check viral load at 1 month post-switch to ensure continued viral suppression, with continued monitoring every 3 months for the first year after switching, as recommended by clinical guidelines 1, 2, 4
Patients unable to attend their scheduled injections need additional close attention and interventions to bring them back to care, based on evidence from clinical trials 3

Never discontinue Biktarvy without immediately starting an effective alternative regimen due to the risk of developing resistance, according to clinical guidelines 1
Do not switch to Apretude if there is a history of resistance to cabotegravir, based on evidence from clinical trials 3
For patients with chronic HBV, do not switch to a regimen without anti-HBV activity (Biktarvy contains tenofovir alafenamide which is active against HBV), as recommended by clinical guidelines 1, 4