Bictegravir
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Trade Name
Biktarvy (brand name; no generic yet); combination of bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF)
Classification
Antiretroviral combination; integrase strand transfer inhibitor (INSTI) + nucleoside reverse transcriptase inhibitors (NRTIs)
Dosage/Route
- * Dosage: Fixed-dose tablet: 50 mg bictegravir, 200 mg emtricitabine, 25 mg tenofovir alafenamide
- * Route: Oral (PO)
Usual Dosage
- * Adults/Children (≥25 kg): 1 tablet PO once daily, with or without food
- * No dose adjustment for mild-moderate renal/hepatic impairment; avoid if CrCl <30 mL/min (unless on dialysis)
Mechanism of Action
- * Bictegravir: Inhibits HIV integrase, preventing viral DNA integration into host genome
- * Emtricitabine/Tenofovir Alafenamide: Inhibit HIV reverse transcriptase, blocking viral RNA to DNA conversion. Together, they suppress HIV replication, reducing viral load
Side Effects & Adverse Effects
- * Side Effects: Nausea, diarrhea, headache, fatigue
- * Adverse Effects:
- – Lactic acidosis/hepatomegaly (rare; boxed warning for NRTIs)
- – Renal impairment (tenofovir; monitor CrCl)
- – Immune reconstitution syndrome (IRIS; inflammation as immunity recovers)
- – Bone density loss (tenofovir-related)
Nursing Management (Implications & Teachings)
- * Implications:
- – Monitor renal function (CrCl, urine protein) and liver enzymes baseline/periodically.
- – Assess for lactic acidosis signs (weakness, abdominal pain, dyspnea).
- – Ensure adherence (missed doses increase resistance risk).
- – Check for drug interactions (e.g., avoid rifampin, antacids with bictegravir).
- * Teachings:
- – Take same time daily; don’t skip doses.
- – Report yellow skin, dark urine, or severe fatigue.
- – Use barrier contraception (doesn’t prevent HIV transmission).
- – Avoid OTC antacids within 2 hours of dose
Indication for This Patient
HIV-1 infection: Complete regimen for treatment-naïve adults or virologically suppressed patients switching therapy (no prior INSTI resistance)
Time
- * Timing: Once daily, any time (consistency key)
- * Onset: Viral load reduction in days to weeks; full suppression in months
- * Duration: Lifelong unless switched
