Background
Bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) is a single-tablet regimen (STR) with no recommendations from the manufacturer regarding crushing or dissolving tablets for adult use. However, oral ingestion may be impractical for hospitalized individuals requiring enteral feeding. Despite some healthcare institutions administering B/F/TAF in crushed or dissolved form in such cases, there is limited clinical evidence regarding the efficacy of this approach.
Methods
Electronic health records from Massachusetts General Hospital and Brigham and Women’s Hospital were reviewed from December 2016 to December 2023 to evaluate the virologic outcomes of people living with HIV who received crushed or dissolved B/F/TAF administered via enteral tube for at least 7 days during inpatient hospitalization. The primary end point was continued or achieved viral suppression (<200 copies/mL) after administration of crushed or dissolved B/F/TAF within a 12 month follow up period. Secondary endpoints included the development of antiretroviral resistance and change in antiretroviral therapy (ART).
Results
From the initial cohort of 54 patients, 22 were excluded for having less than 7 days of B/F/TAF via tube and 13 were excluded for not having a follow-up viral load available within 12 months. A total of 19 patients (84%M) were included in the study and received crushed or dissolved B/F/TAF for a median of 19 days (IQR = 7.5, 64). The need for tube administration was characterized as intubation in 74% (n = 14) of the study cohort. Of the 19 patients for which a follow-up viral load was available, 89% (n = 17) were found to be undetectable. A total of 8 patients had a detectable viral load at the time of admission, and 6 of them showed an undetectable viral load within a year of receiving B/F/TAF via tube. Both patients with a detectable viral load at baseline showed a 2.8 and 3.3 log reduction in viral load at follow-up.
Conclusions
The ability of B/F/TAF to garner or maintain viral suppression when given via tube was demonstrated in our study population. Although this study is limited by its retrospective nature and lack of therapeutic drug monitoring the absence of emergent resistance or virologic failure following crushed B/F/TAF remains reassuring and suggests that providing the STR via tube while patients are NPO is a reasonable alternative to changing ART altogether.
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