Biktarvy is a three-in-one fixed-dose combination antiretroviral medication containing bictegravir (BIC), emtricitabine (FTC), and tenofovir alafenamide (TAF). It is used for the treatment of HIV-1 infection in adults. Its high efficacy and convenience have made it a commonly used clinical regimen, but it must be used in strict compliance with medication guidelines.
Precautions for Biktarvy Administration
Contraindicated Concomitant Medications
Dofetilide: May cause severe arrhythmias.
Rifampin: Significantly reduces the plasma concentration of bictegravir, leading to treatment failure or drug resistance.
Conditions Requiring Caution
Drugs containing polyvalent cations (e.g., aluminum/magnesium-containing antacids, calcium/iron supplements): Administration must be separated by an interval of at least 2 hours to avoid affecting absorption.
Nephrotoxic drugs: May exacerbate renal function impairment.
Medication in Special Populations
Renal impairment: Contraindicated in patients with a creatinine clearance (CLcr) < 30 mL/min.
Hepatic impairment: Contraindicated in patients with severe hepatic impairment (Child-Pugh Class C); close monitoring is required for patients with mild to moderate hepatic impairment.
Other Key Precautions
Principle of complete regimen: Biktarvy is a complete treatment regimen, and concurrent use with other anti-HIV drugs is prohibited.
Management of missed doses: If a missed dose is discovered within 18 hours, take the missed dose immediately; if more than 18 hours have passed, skip the missed dose and take the next dose as scheduled.
Medication Monitoring for Biktarvy
Pre-Treatment Baseline Assessment
Hepatitis screening: All patients must be tested for hepatitis B virus (HBV) infection status. For patients with concurrent HBV infection, liver function must be continuously monitored for several months after discontinuing Biktarvy.
Renal function tests: Including serum creatinine, estimated glomerular filtration rate (eGFR), urine protein, and urine glucose. For patients with chronic kidney disease, additional measurement of serum phosphorus is required.
Routine Monitoring During Treatment
Regular rechecks: Periodically recheck serum creatinine and eGFR, especially when concomitantly using nephrotoxic drugs.
Vigilance for complications: Be alert to Fanconi syndrome (e.g., hypophosphatemia, positive urine glucose) or acute kidney injury.
Liver function monitoring: Pay attention to transaminase and bilirubin levels; enhanced monitoring is required for patients with concurrent HBV infection.
Metabolic indicators: Regularly test fasting blood lipids (e.g., LDL-C) and lactic acid levels (to alert for lactic acidosis).
