Therapy initiation and rapid start with Bictegravir/Emtricitabine/Tenofovir Alafenamide in PLWH

Abstract

Advanced HIV naive represents an unfavorable prognostic condition due to a persistent high risk of death, increased probability of virological failure, immunologic impairment, clinical progression, and immune reconstitution inflammatory syndrome (IRIS), cumulative adverse drug events, drug-drug interactions and increased healthcare costs. Currently, all international guidelines recommend the rapid initiation of ART, especially in late-stage naive patients. Bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF), due to its efficacy high genetic barrier, good safety profile, and low DDI potential, is one of the regimens recommended for overall rapid initiation by international guidelines. B/F/TAF has been tested in observational or uncontrolled pilot studies (OPERA, RAINBOW), while a large randomized controlled trial is currently ongoing (LAPTOP). In conclusion, B/F/TAF is an ideal combination for the initiation of antiretroviral therapy, particularly in the HIV late presenter or advanced HIV disease patient, even in the context of rapid start or same-day treatment regimens, where the initiation of treatment usually occurs in the absence of information on viral load, CD4 count, biochemical profile and HIV transmitted resistance.

Keywords: Bictegravir; Emtricitabile; PLWH; Tenofovir.

Figure 1

Association between regimen and (A) reaching a CD4 cell count ≥200 cells/μ3, or (B) changes in CD4/CD8 ratio from index. (modified from Mounzer K, et al. 24^th International AIDS Conference - AIDS 2022; Abst.#EPB148).

Figure 2

Rates of Virologic Suppression and CD4 Count >200 Cells/μL in the Rainbow Study (modified from Camici M, et al. 24^th International AIDS Conference - AIDS 2022; Abst.#EPB151).

Figure 3

Viral decay, immunological results, and eGFR average trend for 48 weeks in the Rainbow Study (modified from Camici M, et al. 24^th International AIDS Conference - AIDS 2022; Abst.#EPB151).