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Bictegravir/TAF/FTC in Women
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The single-pill combination of bictegravir (BIC) with tenofovir alafenamide (TAF) and emtricitabine (FTC), recently approved by the FDA, has been shown in four Phase III trials to be effective as initial therapy and as a switch regimen in patients with stably suppressed HIV RNA and no resistance to BIC, TAF, or FTC. In these studies, <15% of participants were women. At CROI 2018, researchers presented results of a switch trial done in women. This was an international open-label study in which 470 women with virologic suppression on a regimen consisting of elvitegravir/cobicistat/tenofovir/FTC (95%) or atazanavir + ritonavir + TDF/FTC (5%) were randomized to switch to BIC/TAF/FTC or to stay on their baseline regimen. At week 48, 96% of the switch group and 95% of the comparator group maintained HIV RNA <50 copies/mL, with no differences in efficacy by race or geographic region. No resistance emerged in the few subjects with virologic failure on BIC, while 1 subject in the baseline regimen group developed M184M/I/V mutations. No significant differences were noted in rates of adverse events or in eGFR or proteinuria.

Clinical Bottom Line

This study showed that BIC/TAF/FTC is effective and safe as a switch regimen in women with stable viral suppression and no predicted ARV resistance. These results are not surprising but nonetheless are reassuring. Further investigation will be needed to determine whether BIC/TAF/FTC is safe for use during pregnancy.

Reference
Kityo C, Hagins D, Koenig E, et al. Switching to bictegravir/emtricitabine/tenofovir alafenamide (B/F/Taf) in women. In: Program and abstracts of the 2018 Conference on Retroviruses and Opportunistic Infections; March 4-7, 2018; Boston. Abstract 500.