Real-world efficacy and safety of switching to bictegravir/emtricitabine/tenofovir alafenamide in older people living with HIV

Medicine (Baltimore). 2021 Sep 24;100(38):e27330. doi: 10.1097/MD.0000000000027330.


Approximately 50% of people living with HIV (PLWH) in the United States are ≥50 years old. Clinical trials of bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) demonstrated potent efficacy and favorable safety in older PLWH; however, real-world data would be useful to validate these results.Retrospective cohort study.We evaluated records from PLWH aged ≥50 years at the Orlando Immunology Center who were switched to B/F/TAF between February 2018 and August 2019. Eligible patients had baseline HIV-1 RNA <50 copies/mL and 48 weeks of follow-up data. The primary endpoint was maintenance of HIV-1 RNA <50 copies/mL at Week 48. The impact of switching to B/F/TAF on drug-drug interactions (DDIs) and safety parameters were also assessed.Three-hundred and fifty patients met inclusion criteria, median age was 57 years, 20% were women, and 43% were non-White. Fifty-five percent of patients switched from integrase inhibitor-based regimens; the most common reason for switch was simplification. At Week 48, 330 (94%) patients maintained an HIV-1 RNA <50 copies/mL and 20 (6%) had an HIV-1 RNA between 50 and 400 copies/mL. One-hundred and forty potential DDIs were identified in 121 (35%) patients taking a boosting agent or rilpivirine at baseline that were resolved after switching to B/F/TAF. Treatment-related adverse events occurred in 51 (15%) patients (all Grade 1-2) and led to 8 discontinuations.In this real-world cohort, switching to B/F/TAF was associated with maintenance of virologic control, and avoidance of DDIs in a large proportion of patients. These data support use of B/F/TAF as a treatment option in older PLWH.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Alanine / therapeutic use*
  • Drug Combinations
  • Drug Substitution
  • Emtricitabine / therapeutic use*
  • Female
  • HIV Infections / drug therapy*
  • Humans
  • Male
  • Middle Aged
  • Piperazines / therapeutic use*
  • Pyridones / therapeutic use*
  • Retrospective Studies
  • Tenofovir / therapeutic use*
  • Treatment Outcome


  • Drug Combinations
  • Piperazines
  • Pyridones
  • bictegravir, emtricitabine, tenofovir alafenamide, drug combination
  • Tenofovir
  • Emtricitabine
  • Alanine