Extending follow-up visits in people with HIV (PWH) receiving bictegravir/ emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) therapy: an expert opinion

Our confidence on the efficacy of antiretroviral therapy has steadily increased in the last decade thanks to the continuous improvement of drugs, strategies and the ability to cope with the increase in life expectancy of people with HIV (PWH). Nevertheless antiretroviral therapy keeps on being a lifelong commitment and the current clinical research on anti-HIV treatment also points on the possibility to mitigate a series of remaining difficulties like patients' adherence, stigma and the logistic burden associated to periodical monitoring and drug refills. The newly developed long-acting injectables drugs made it possible to reduce the frequency of administration and improved adherence, but at present the recipients of these new solutions are asked to join the outpatient HIV services at least every two months to receive their injections and undergo immunovirological monitoring. This also because these newly developed options consist of two (2DR) instead of three drugs and such close monitoring might be necessary due to the lesser genetic barrier and forgiveness. The patients who instead are under stable oral antiretroviral therapy with persistent virologic suppression may benefit from extension of the time between consecutive controls. This particularly applies when 2^nd generation integrase inhibitors (INSTIs)-based three-drug regimens (3DR) are considered. Properties like intrinsic potency, genetic barrier, forgiveness, tolerability and safety make such regimens well suitable for less frequent immunovirological monitoring. The case of the single-tablet regimen consisting of Bictegravir/Emtricitabine/Tenofovir alafenamide (BIC/FTC/TAF) is unique, as in a single pill with a total net weight of 275 mg we actually find all the necessary ingredients to ensure the success of such initiative. Such powerful option looks as the most promising treatment to successfully increase the time between consultations and monitoring up to 9 or 12 months and thus providing the resulting advantages.