The multifaceted antiretroviral coverage provided by BIC/FTC/TAF: a pharmacokinetic/pharmacodynamic revisitation

The treatment of HIV infection has entered a dichotomous phase, as established oral regimens are now sharing the landscape with long acting injectable combination therapies. By looking at the new antiretrovirals in the pipeline it is apparent that the future of HIV treatment will be largely covered by long-acting regimens, with an increasing shift toward injectable formulations allowing much less frequent administration; in parallel, the development of novel once-daily oral combinations, as well as oral long acting therapies is expected to further expand treatment options. However, the current HIV-infected population still includes a large proportion of patients with a variety of immunovirological conditions whose weaknesses require the currently available strongest option, such as a triple oral regimen including a 2nd generation integrase strand-transfer inhibitor (INSTI) like the co-formulation containing Bictegravir (BIC), Emtricitabine (FTC) and Tenofovir alafenamide (TAF). Further to a proportion of newly diagnosed HIV infections at an advanced disease stage still exceeding 50%, many are the patients whose history may include a late start of treatment, virologic failures and a suboptimal immune recovery. BIC/FTC/TAF is the point of arrival of decades of antiretroviral research and has the pharmacologic characteristics to guarantee the therapeutic success in most patients with difficult-to treat infections. Properties like intrinsic potency, strong genetic barrier and forgiveness of BIC/FTC/TAF are unique among currently available antiretroviral regimens and make this single tablet combination as the gold standard for comparative studies of new therapeutic solutions. The main clinical-pharmacologic features of BIC/FTC/TAF are here analysed with the intention to focus on some key advantages this regimen may offer whenever the individual conditions are less than ideal for other regimens.