Biktarvy is a once-daily, single-tablet regimen (STR) developed by Gilead Sciences. It combines three potent active ingredients: bictegravir, emtricitabine, and tenofovir alafenamide. Each of these components plays a crucial role in hindering the replication of the HIV virus within the body.

It’s primarily prescribed for the treatment of HIV-1 infection in adults and adolescents who weigh at least 25 kilograms (approximately 55 pounds). Its effectiveness has been established in both treatment-naive individuals and those who have already undergone HIV treatment.

This medications efficacy stems from its ability to target different stages of the HIV replication cycle. Bictegravir, a powerful integrase strand transfer inhibitor (INSTI), works by preventing the integration of viral DNA into the host cell’s DNA. Emtricitabine and tenofovir alafenamide are both nucleoside reverse transcriptase inhibitors (NRTIs) that impede the reverse transcription process, inhibiting the virus from producing new DNA.

Biktarvy is highly effective against HIV-1 strains that are sensitive to the individual components of the medication. It is essential for healthcare providers to conduct proper testing to ensure the patient’s virus is susceptible to these medications before initiating treatment.

Numerous clinical trials have demonstrated Biktarvy’s superior efficacy compared to other ART regimens. Studies have shown that Biktarvy effectively reduces the viral load to undetectable levels, allowing individuals to lead healthy lives and reduce the risk of transmitting the virus to others.

Beyond clinical trials, real-world data has confirmed Biktarvy’s impressive effectiveness. Patients taking Biktarvy consistently achieve viral suppression, promoting immune system recovery and improving overall health outcomes.

Warnings and Precautions of Biktarvy

Biktarvy is an essential medication in the management of HIV-1 infection, but it is crucial to be aware of the warnings and precautions associated with its use. Understanding the potential risks and safety measures can help individuals make informed decisions about their treatment. Always follow your healthcare provider’s guidance and report any concerning symptoms promptly.

Consultation with a Healthcare Professional

Before starting Biktarvy, it is crucial to consult with a qualified healthcare professional, such as an HIV specialist or an infectious disease specialist. Healthcare providers must conduct a comprehensive medical history assessment. Patients should disclose any existing medical conditions, allergies, or past adverse drug reactions. Special attention should be given to kidney and liver function, as Biktarvy may impact these organs.

Hepatitis B Coinfection

In patients with HIV-1 and hepatitis B virus (HBV) coinfection, abrupt discontinuation of Biktarvy can lead to severe acute exacerbations of HBV. Therefore, closely monitor patients with both infections and consider appropriate management strategies.

Drug Resistance

Biktarvy should not be used as the sole therapy in patients with known or suspected HIV-1 resistance mutations. Resistance testing should be conducted before initiating treatment to ensure its efficacy.

Immune Reconstitution Syndrome

When starting HIV treatment, some individuals may experience an inflammatory response from the recovering immune system. This condition is known as immune reconstitution syndrome and can manifest in various ways. It is essential to inform your healthcare provider of any new or worsening symptoms.

More information under Severe Side Effects.

Lactic Acidosis and Severe Hepatomegaly

Rare cases of lactic acidosis (a buildup of lactic acid in the blood) and severe hepatomegaly (enlarged liver) have been reported with the use of nucleoside analogs, including tenofovir alafenamide. Patients should be alerted to any signs of unexplained weakness, muscle pain, or abdominal discomfort and seek immediate medical attention if these symptoms occur.

More information under Severe Side Effects.

Allergic reactions

Some individuals may experience allergic reactions to one or more components of Biktarvy. If you notice symptoms such as hives, difficulty breathing, or swelling of the face, lips, tongue, or throat, seek immediate medical attention.

More information under Rare Side Effects.

Liver problems

Biktarvy may cause liver problems, especially in individuals with pre-existing liver conditions. Regular monitoring of liver function is necessary while taking this medication. If you experience symptoms like yellowing of the skin or eyes, dark urine, or persistent abdominal pain, contact your healthcare provider promptly.

More information under Severe Side Effects.


There have been reports of liver-related adverse events with the use of Biktarvy. Patients with pre-existing liver conditions or those taking medications known to cause liver damage should be closely monitored while on Biktarvy.

Renal Impairment

Biktarvy should be used with caution in patients with renal impairment, as tenofovir alafenamide may cause kidney-related adverse reactions. Regular monitoring of renal function is essential, and the dose should be adjusted as necessary.

Bone Loss and Mineralization Defects

Long-term use of tenofovir alafenamide, one of the active ingredients in Biktarvy, may lead to bone loss, increasing the risk of fractures. Individuals with a history of bone issues or those at risk for osteoporosis should be closely monitored during treatment.

Adverse Reactions with Coadministration

Biktarvy should not be coadministered with certain medications due to the risk of serious adverse reactions or reduced efficacy. Patients should inform their healthcare providers about all medications they are taking to prevent potential interactions.

Risk of Transmission of HIV-1 Infection

Biktarvy is not a cure for HIV-1 infection and does not prevent its transmission to others. Patients should continue practicing safe sex and take other preventive measures to reduce the risk of transmission

Pregnancy and Breastfeeding

If you are pregnant or planning to become pregnant, discuss the risks and benefits of using Biktarvy with your healthcare provider. It is essential to consider the potential impact on both the mother and the unborn child. Similarly, breastfeeding individuals should consult their healthcare provider to assess the benefits and risks of using Biktarvy during lactation.

Side Effects

Biktarvy has undoubtedly revolutionized the treatment of HIV-1 infection, offering a potent combination of antiretroviral drugs. However, it is essential for patients and healthcare providers to be aware of the potential side effects that may accompany this medication. While most side effects are mild and transient, some can be severe and require immediate medical attention. Open communication with healthcare providers and regular monitoring can ensure the safe and effective use of Biktarvy.

Common Side Effects of Biktarvy

Like any other medication, Biktarvy may cause some common side effects that are usually mild and temporary. These side effects often dissipate as the body adjusts to the medication. The most frequently reported common side effects include:

Nausea and Vomiting

Some individuals may experience mild nausea or occasional vomiting when they first start taking Biktarvy. This can often be managed by taking the medication with food.


Headaches are another relatively common side effect reported by some patients. Staying hydrated and taking over-the-counter pain relievers can help alleviate this symptom.


Diarrhea may occur in some individuals, but it often subsides within a few days. Staying hydrated is crucial to prevent any dehydration associated with diarrhea.


Feeling fatigued or experiencing a general sense of tiredness can be a common side effect of Biktarvy. Engaging in regular physical activity and maintaining a balanced diet can help combat fatigue.

Rare Side Effects of Biktarvy

While the majority of individuals tolerate Biktarvy well, there are some rare side effects that may manifest. These side effects are less common but warrant attention and medical evaluation if experienced. Some of the rare side effects include:

Allergic Reactions

In some cases, individuals may develop allergic reactions to one or more components of Biktarvy. Symptoms may include skin rash, itching, difficulty breathing, or facial swelling. Seek immediate medical attention if an allergic reaction is suspected.

Liver Problems

In rare instances, Biktarvy may lead to elevated liver enzyme levels. Regular monitoring by a healthcare provider can help detect this early and prevent any serious complications.

Mood Changes

Though uncommon, some patients may experience mood changes or feelings of depression while taking Biktarvy. If these symptoms persist or worsen, it’s essential to discuss them with a healthcare professional.

Severe Side Effects of Biktarvy

Severe side effects of Biktarvy are exceptionally rare, but they require prompt medical intervention. If any of the following severe side effects are observed, immediate medical attention is necessary:

Lactic Acidosis

Lactic acidosis is a severe condition characterized by the buildup of lactic acid in the body. Though extremely uncommon, it can be life-threatening. Symptoms may include weakness, rapid breathing, abdominal pain, and dizziness. If any of these symptoms occur, seek emergency medical attention.

Kidney Problems

In rare cases, Biktarvy may cause kidney-related issues, including acute kidney injury or Fanconi syndrome. Patients should be aware of any changes in urine output or signs of kidney dysfunction and promptly report them to their healthcare provider.

Bone Density Loss

Prolonged use of Biktarvy may contribute to bone density loss, leading to an increased risk of fractures. Patients with existing osteoporosis or other bone conditions should be closely monitored.

Immune Reconstitution Syndrome

In some cases, initiating Biktarvy can lead to an immune reconstitution syndrome, where the immune system responds dramatically to the presence of HIV. This might cause inflammatory reactions or worsening of existing infections.


Interactions with Biktarvy can influence the effectiveness and safety of this vital HIV-1 medication. To ensure the best possible treatment outcomes, it’s essential to inform your healthcare provider about all medications, herbal supplements, and foods you are taking. By staying vigilant and proactive, you can effectively manage potential interactions and continue on your journey to a healthier life with Biktarvy.

Drug Interactions

Drug interactions can impact the efficacy and safety of Biktarvy treatment. It is essential to inform your healthcare provider about all the medications you are taking, including prescription, over-the-counter, and herbal supplements. Here are some key drug interactions with Biktarvy:

  1. Antacids: Taking certain antacids alongside Biktarvy may reduce the absorption of the medication, potentially compromising its effectiveness. Avoid taking antacids within a few hours of Biktarvy administration.
  2. Proton Pump Inhibitors (PPIs): PPIs used to treat acid reflux and peptic ulcers might reduce the absorption of tenofovir alafenamide in Biktarvy. Consider alternative medications or adjust the timing of administration in consultation with your healthcare provider.
  3. St. John’s Wort: This herbal supplement, commonly used to alleviate depression and anxiety, can significantly reduce the levels of bictegravir in the bloodstream. Avoid using St. John’s Wort while on Biktarvy.
  4. Anticonvulsants: Some anticonvulsant medications, such as phenytoin and carbamazepine, may lower Biktarvy levels, reducing its efficacy. Close monitoring and dose adjustments may be necessary.
  5. Methadone: Co-administration of Biktarvy with methadone can affect methadone levels in the body, potentially leading to withdrawal symptoms or decreased effectiveness of methadone.
  6. Cobicistat-Containing Medications: Biktarvy contains cobicistat, and taking other medications that also contain cobicistat may lead to an overdose of this component. Ensure your healthcare provider is aware of all your medications.

Herbal Interactions

Herbal supplements are widely used for various health benefits, but they can interact with medications, including Biktarvy. Understanding these interactions is crucial to prevent adverse effects. Here are some significant herbal interactions with Biktarvy:

  1. Garlic: Garlic supplements may reduce the effectiveness of Biktarvy by increasing the breakdown of the medication in the liver. Avoid using high doses of garlic supplements.
  2. Echinacea: Echinacea is often used to boost the immune system, but it may interact with Biktarvy, potentially reducing the medication’s antiviral efficacy.
  3. Ginkgo Biloba: This popular herbal supplement might interfere with the metabolism of Biktarvy, leading to altered drug levels in the body.
  4. Saw Palmetto: Saw palmetto is commonly used for prostate health, but it may interact with Biktarvy, potentially affecting the absorption or elimination of the medication.
  5. Milk Thistle: Milk thistle is known for its liver-protective properties, but it could potentially alter the metabolism of Biktarvy, leading to unexpected effects.
  6. Grapefruit: While not an herbal supplement, grapefruit and its juice can interact with Biktarvy, affecting drug levels and potentially leading to side effects.

Food Interactions

Certain foods can interact with Biktarvy and influence its absorption, distribution, and metabolism in the body. Understanding these interactions is crucial for optimal treatment outcomes. Here are some significant food interactions with Biktarvy:

  1. High-Fat Meals: Taking Biktarvy with a high-fat meal may increase the absorption of the medication, potentially leading to higher drug levels. It is advisable to take Biktarvy consistently with or without food.
  2. Calcium-Rich Foods: Foods rich in calcium, such as dairy products, can reduce the absorption of tenofovir alafenamide in Biktarvy. Consider taking Biktarvy separately from calcium supplements or calcium-rich meals.
  3. Iron Supplements: Iron supplements might decrease the absorption of Biktarvy, potentially affecting its effectiveness. Space out the administration of iron supplements and Biktarvy if needed.
  4. Alcohol: While moderate alcohol consumption is generally safe, excessive alcohol intake can strain the liver, potentially affecting Biktarvy metabolism.
  5. Grapefruit Juice: As mentioned earlier, grapefruit juice can interact with Biktarvy, so it’s best to avoid it or consume it in moderation.

Strengths and Dosages

Biktarvy’s unique formulation combines the following ingredients:

  1. Bictegravir: A novel integrase strand transfer inhibitor (INSTI) that hinders HIV replication by preventing the integration of viral DNA into the host cell’s DNA.
  2. Emtricitabine: A nucleoside reverse transcriptase inhibitor (NRTI) that interferes with the virus’s ability to replicate its genetic material.
  3. Tenofovir alafenamide: Another NRTI that exhibits potent antiviral activity and is less likely to cause renal and bone toxicity compared to its predecessor, tenofovir disoproxil fumarate.

Different Strengths Available

Biktarvy comes in various strengths to accommodate different patient needs and treatment stages. The most commonly prescribed strengths include:

  1. 50mg/200mg/25mg: This is the standard strength of Biktarvy and is suitable for most adult patients who are starting HIV treatment for the first time.
  2. 100mg/200mg/25mg: This higher strength is primarily recommended for individuals with no history of antiretroviral treatment or those who are switching from another HIV medication.
  3. 50mg/200mg/25mg pediatric formulation: Biktarvy also offers a pediatric formulation suitable for children weighing at least 25kg (approximately 55lbs).

Recommended Dosages for Various Populations

The appropriate dosage of Biktarvy depends on several factors, including a patient’s previous treatment history, age, weight, and existing medical conditions. It is essential to consult with a healthcare professional to determine the correct dosage that best suits an individual’s needs.

IMPORTANT NOTE: The information provided here is for educational purposes only and is not intended to serve as medical advice, diagnosis, or treatment recommendations. It should not be taken as an endorsement of any specific medication or treatment. Individual health conditions and responses to treatment can vary greatly; therefore, this information should not be seen as a guarantee of safety, suitability, or effectiveness for any particular individual. Always consult with a healthcare professional for personalized medical advice and before making any decisions regarding your health or treatment plans.

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