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# Bictegravir/Emtricitabine/Tenofovir Alafenamide (B/FTC/TAF)
## Overview
Bictegravir/emtricitabine/tenofovir alafenamide is a single-tablet regimen (STR) for the treatment of human immunodeficiency virus type 1 (HIV-1) infection. It contains an integrase strand transfer inhibitor (INSTI), a nucleoside reverse transcriptase inhibitor (NRTI), and a nucleotide reverse transcriptase inhibitor (NtRTI).
## Primary Indications
Treatment of HIV-1 infection in adults and pediatric patients weighing at least 25 kg who have no known history of treatment with an antiviral medication for HIV-1.
## Adult Dosing
One tablet (bictegravir 15 mg/emtricitabine 200 mg/tenofovir alafenamide 10 mg) orally once daily.
## Pediatric Dosing
For pediatric patients weighing at least 25 kg: One tablet (bictegravir 15 mg/emtricitabine 200 mg/tenofovir alafenamide 10 mg) orally once daily. Dosing for pediatric patients weighing less than 25 kg is not established.
## Dose Adjustments
No dose adjustment is necessary based on age, sex, race, or renal impairment.
Dose adjustment is necessary in patients with severe hepatic impairment.
## Contraindications
* Known hypersensitivity to bictegravir, emtricitabine, tenofovir alafenamide, or any component of the tablet.
* Use with dofetilide.
## Adverse Effects
Common adverse effects include diarrhea, nausea, headache, and fatigue. Less common but serious adverse effects can include hypersensitivity reactions, immune reconstitution inflammatory syndrome (IRIS), and potential renal or bone toxicity (though less than with tenofovir disoproxil fumarate).
## Key Drug Interactions
* **Dofetilide:** Contraindicated due to increased dofetilide concentrations and risk of serious ventricular arrhythmias.
* **Anticonvulsants (e.g., carbamazepine, phenytoin):** May decrease bictegravir concentrations.
* **Rifampin:** May decrease bictegravir concentrations.
* **St. John's Wort:** May decrease bictegravir concentrations.
* **Divalproex sodium:** May increase bictegravir concentrations.
## Monitoring
* Monitor HIV-1 RNA and CD4 count at baseline and regularly thereafter.
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor renal function, serum electrolytes, and urinalysis at baseline and periodically.
* Monitor bone mineral density periodically in patients with a history of fractures or other risk factors for osteoporosis or bone loss.
## Clinical Pearls
* B/FTC/TAF is a preferred regimen for initial HIV-1 treatment due to its high barrier to resistance, favorable safety profile, and convenient single-tablet dosing.
* It can be taken with or without food.
* For patients with severe hepatic impairment, this regimen is not recommended.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making treatment decisions. Dosing and recommendations may vary based on local protocols and individual patient factors.*
