Switching from Current ART Regimen to Biktarvy

Rationale for Switching

• The American Medical Association recommends switching from a boosted protease inhibitor regimen to an integrase strand transfer inhibitor regimen like Biktarvy for patients with virologic suppression and no history of resistance 1, 2
• Biktarvy provides several advantages over the current regimen, including single-tablet, once-daily dosing, which improves convenience and potentially adherence 1
• Replacement of zidovudine with Biktarvy is recommended due to long-term toxicity concerns associated with zidovudine 3
• Biktarvy avoids potential renal and bone toxicity associated with tenofovir disoproxil fumarate 1

Prerequisites Before Switching

• Review of treatment history and results of prior resistance testing is mandatory before making any treatment changes, according to the International Antiviral Society-USA guidelines 4, 1
• Confirm that the patient has no history of InSTI resistance, NRTI resistance, or virologic failure on previous regimens 2, 1
• Verify current virologic suppression, defined as HIV RNA <50 copies/mL, before switching to Biktarvy 2

Switching Process

• The switch to Biktarvy can be made on the same day without a lead-in period if there is no resistance, as recommended by the American Medical Association 1
• Discontinue all components of the previous regimen and start Biktarvy once daily, with a recommended dosage of bictegravir 50 mg/emtricitabine 200 mg/tenofovir alafenamide 25 mg 1

Monitoring After Switch

• Assess HIV viral load 1 month after switching regimens, and continue monitoring every 3 months for the first year, then at least every 6 months thereafter if the patient remains stable, as recommended by the International Antiviral Society-USA guidelines 2, 4

Special Considerations

• If the patient has hepatitis B virus co-infection, Biktarvy is an appropriate treatment option, as it contains tenofovir alafenamide, which is active against HBV 2
• If the patient has renal impairment, Biktarvy is generally preferred over regimens containing tenofovir disoproxil fumarate, according to the American Medical Association 1

Potential Pitfalls to Avoid

• Do not switch to Biktarvy if there is any history of resistance to integrase inhibitors or the NRTI components, as recommended by the International Antiviral Society-USA guidelines 1, 2
• Do not switch without reviewing complete treatment history and resistance testing results, as emphasized by the American Medical Association 4
• Avoid switching if the patient is taking medications with significant drug interactions with Biktarvy, as warned by the American Medical Association 1