A New Combined Antiretroviral Therapy In Adolescents With HIV: Bictegravir/Emtricitabine/Tenofovir Alafenamide

Abstract

AIM: We aimed to evaluate the treatment response and side effect profile of bictegravir as initial therapy in HIV-naive adolescents. BACKGROUND: Bictegravir is a potent integrase helicase transfer inhibitor with a high genetic barrier to resistance. Bictegravir, formulated together with emtricitabine and tenofovir alafenamide(BIC/FTC/TAF), is recommended for children over 25 kg in US and European HIV pediatric treatment guidelines as the preferred single-tablet regimen for adults and adolescents. METHODS: The files of HIV-naive adolescent patients aged 12-18 years and weighing ≥25 kg who received a fixed-dose regimen of bictegravir50 mg, emtricitabine200 mg, and tenofovir alafenamide25 mg once daily for ≥6 months at Istanbul Medical Faculty Hospital in 2023 were retrospectively evaluated. Demographic characteristics, drug side effects, HIV RNA copies, clinical and immunological stages were evaluated. RESULTS: BIC/FTC/TAF was started in eight adolescent patients with HIV, but 4 HIV-naive adolescents aged 15-17 were included in our study. Their viral loads at the time of admission were between 2790-1,580,000 copies/mL. In their follow-up, it was found that all patients had a plasma viral load of <50 copies/mL after 6 months of treatment. With BIC/FTC/TAF, thanks to all our patients with high treatment compliance, no side effects observed, and in whom we detected complete virological suppression, the drug was evaluated as having reached its goal of a treatment regimen that is maximum effective and facilitates compliance in the adolescent age group. CONCLUSION: BIC/FTC/TAF may be particularly useful in the pediatric population due to low adherence to treatment and high risk of viral failure.

Keywords

• HIV
• adolescent
• bictegravir
• antiretroviral
• treatment