bictegravirbased

Bictegravir-based refers to antiretroviral therapy regimens that center on the integrase strand transfer inhibitor bictegravir. Bictegravir blocks the HIV integrase enzyme, preventing the integration of viral DNA into the host genome and thereby inhibiting viral replication. In practice, bictegravir-based regimens are typically combined with two nucleoside reverse transcriptase inhibitors, most commonly emtricitabine and tenofovir alafenamide, in a single fixed-dose formulation such as bictegravir/emtricitabine/tenofovir alafenamide. These regimens are usually taken once daily and do not require boosting.

Clinical use and guideline role: Bictegravir-based regimens are approved for treatment-naïve adults and are also used as switch therapy in virologic suppression on a bictegravir-containing backbone. They are widely recommended as standard first-line therapy in many international HIV treatment guidelines due to strong efficacy, a high barrier to resistance, favorable tolerability, and convenient dosing. They may be chosen for patients who prefer a single-tablet, once-daily regimen with a limited drug interaction profile, subject to individual contraindications and comorbidities.

Safety and tolerability: Common adverse events include diarrhea, nausea, and headache; weight changes have been reported with integrase inhibitors, including bictegravir. Bictegravir can interact with polyvalent cations and certain other medications, requiring dosing separation. As with other ART regimens, monitoring for viral suppression and resistance is essential.

Resistance and limitations: Bictegravir has a relatively high genetic barrier to resistance, but resistance can develop with insufficient viral suppression or specific integrase mutations. Cross-resistance with other INSTIs has been observed in some scenarios.

Availability: Bictegravir-based regimens are marketed in many countries, with fixed-dose combinations such as bictegravir/emtricitabine/tenofovir alafenamide occupying a prominent role.