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. 2025 Sep;26(9):1375-1394.
doi: 10.1111/hiv.70065. Epub 2025 Jun 26.

Rapid start with bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) as initial treatment in people with human immunodeficiency virus-1 (HIV-1): A systematic literature review of clinical and patient-reported outcomes

Jade Ghosn  1   2 , Jeremy Chow  3 , Monica Gandhi  4 , Miguel Górgolas  5 , Aws Al-Hayani  6 , Hansel Tookes  7 , Max Lee  8 , Emily F Kaiser  8 , David Malebranche  9 , Fernando Alvarez Bognar  9 , Bhumi Gandhi-Patel  9 , Lili Dai  10
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Rapid start with bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) as initial treatment in people with human immunodeficiency virus-1 (HIV-1): A systematic literature review of clinical and patient-reported outcomes

Jade Ghosn et al. HIV Med. 2025 Sep.

Abstract

Background: Treatment guidelines recommend rapid antiretroviral therapy (ART) initiation among eligible people with HIV to improve treatment outcomes and reduce HIV transmission. Bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF), an integrase strand transfer inhibitor-based single-tablet regimen, is recommended for rapid start in US and European guidelines. This systematic literature review synthesized evidence on the efficacy, safety and effect on patient-reported outcomes (PROs) of B/F/TAF rapid start among newly diagnosed people with HIV.

Methods: MEDLINE, Embase, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials databases were searched in January 2024, supplemented by searches of conference proceedings and clinical trial records. English-language interventional studies of B/F/TAF rapid start among ART-naïve people with HIV reporting efficacy, safety or PROs were eligible. Study quality was assessed using York Centre for Reviews and Dissemination or Risk Of Bias In Non-randomized Studies of Interventions checklists. Results were synthesized narratively.

Results: Across eight included studies, 745 people with HIV received B/F/TAF rapid start, 171 received rapid start comparators and 255 received non-rapid start comparators. At Weeks 24 and 48, 80%-94% and 74%-96% of people with HIV treated with B/F/TAF rapid start achieved viral load <50 copies/mL, respectively. Treatment discontinuation due to adverse events was 0%-3%, and grade 3/4 adverse events occurred in 0%-3% of people with HIV receiving B/F/TAF rapid start. Rapid start improved engagement in care over traditional non-rapid start approaches, and B/F/TAF rapid start reduced anxiety and improved quality of life among people with HIV. Limitations of the review included heterogeneous study definitions of "rapid start" and limited data availability.

Conclusions: B/F/TAF rapid start was efficacious, safe and associated with high engagement in care and improved PROs.

Keywords: adherence; engagement in care; immediate start; quality of life; safety; viral suppression.

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Conflict of interest statement

JG: Honoraria from Gilead Sciences, Inc. and ViiV Healthcare. JC: Received grants from Gilead Sciences, Inc. MoG: Nothing to disclose. MiG: Advisory honoraria from Gilead Sciences, Inc., Johnson & Johnson, and ViiV Healthcare. AAH: Received grants and personal fees from ViiV Healthcare; received personal fees from Gilead Sciences, Inc., Janssen, and Merck. HT: Received grants from Gilead Sciences, Inc. and ViiV Healthcare. ML, EFK: Employees of Costello Medical, which received funding from Gilead Sciences, Inc. for conducting this work. DM, FAB, BGP: Employees and shareholders of Gilead Sciences, Inc. LD: Nothing to disclose.

References

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