Does Biktarvy cause hair loss?
Hair loss (alopecia) with the use of Biktarvy has been reported in several case reports, but has not been described in Biktarvy clinical studies conducted by the manufacturer. Tenofovir alafenamide (TAF), the nucleoside/nucleotide reverse transcriptase inhibitor (NRTI) contained in Biktarvy may possibly lead to hair loss.
Biktarvy (bictegravir, emtricitabine, and tenofovir) is a combination integrase inhibitor and nucleoside / nucelotide reverse transcriptase inhibitor (NRTI) used in the treatment of people living with HIV. The NRTI drug class has been rarely associated with hair loss in some patients. The NRTIs in Biktarvy are emtricitabine and tenofovir alafenamide. Biktarvy also contains the integrase inhibitor bictegravir.
It is thought that the NRTI in Biktarvy may cause hair loss (alopecia) due to a decrease in mitochondrial DNA replication in the cell.
Case reports of hair loss with Biktarvy
In case reports in six African American women ages 40 to 61, the use of tenofovir alafenamide (TAF) as part of a Biktary regimen for HIV treatment was reported to lead to scalp hair loss. The women had previously used tenofovir disoproxil fumarate (TDF) before switching to TAF for safety reasons. Hair loss in 4 of 6 women started between 2 and 4 months after starting TAF, but ranged up to one year. Other causes of alopecia were ruled out by the investigators.
To attempt a reversal of the hair loss, 5 of the 6 women were switched to different antiviral treatments, including abacavir / dolutegravir / lamivudine (Triumeq) or dolutegravir / rilpivirine (Juluca). After follow-up, noticeable hair regrowth was seen or reported in five patients within 1 to 5 months. One patient did not switch treatment and had no hair regrowth at 6 and 12 months of follow-up.
Alopecia (hair loss or hair thinning) in patients with human immunodeficiency virus (HIV) may be due to other causes, such as advanced AIDS, anemia, infections related to HIV / AIDS, sexually transmitted diseases, nutritional deficiencies or medication side effects.
Other medicines that can cause hair loss in HIV
Other antiretroviral medications (besides NRTIs) that have been reported to rarely lead to hair loss include the protease inhibitors (PIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs). Two of the active ingredients in Biktarvy, emtricitabine and tenofovir alafenamide, may possibly be associated with hair loss.
- Commonly linked protease inhibitors are indinavir, lopinavir and ritonavir. Biktarvy does not contain a protease inhibitor.
- Among NRTIs, lamivudine, emtricitabine, abacavir, and zidovudine have been reported in a few cases. Emtricitabine is found in Biktarvy.
According to the Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV, some medicines used for the treatment of opportunistic infection in patients with HIV have been associated with alopecia; these include: albendazole, cidofovir, ethionamide, fluconazole, and voriconazole.
Related questions
- Which medicines should not be taken with Biktarvy?
- Can Biktarvy be used for PrEP or PEP?
- What if I miss a dose of Biktarvy?
What should I do?
If you are experiencing hair loss and are concerned it may be due to your antiretroviral medication, contact your doctor. Do not stop taking Biktarvy without talking to your doctor first as this can be dangerous. Your doctor can evaluate you, determine the cause of your hair loss, and switch treatment if needed.
Case reports like the ones for Biktarvy are often small observational reviews and it may be difficult to prove that medicines cause specific side effects with these types of reports. The best way to assess medication side effects is with randomized, controlled trials or to speak with your doctor.
The investigators in this case series determined causality (whether Biktarvy actually caused the hair loss) using the Naranjo Probability Scale, which was a score of +3, indicating a possible causality between tenofovir alafenamide (TAF) and hair loss.
This is not all the information you need to know about Biktarvy (bictegravir, emtricitabine, and tenofovir) for safe and effective use and does not replace your healthcare provider's directions. Review the full product information and discuss this information and any questions you have with your doctor or other health care provider.
References
- Panel on Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV. National Institutes of Health, Centers for Disease Control and Prevention, HIV Medicine Association, and Infectious Diseases Society of America. Jan 31, 2024. Accessed Aug 5, 2025 at https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/common-or-serious-adverse-reactions
- Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV. NIH. Department of Health and Human Services. Sept. 12, 2024. Accessed Aug 5, 2025 at https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/whats-new
- El Zein S, Tabaja H, Kanj A, et al. Alopecia After Switch to Tenofovir Alafenamide in 6 African American Women. Open Forum Infect Dis. 2019;6(7):ofz278. Published 2019 Jun 6. https://doi.org/10.1093/ofid/ofz278
- Woods EA, Foisy MM. Antiretroviral-related alopecia in HIV-infected patients. Ann Pharmacother 2014; 48:1187–93 https://doi.org/10.1177/1060028014540451
- Biktarvy [prescribing information]. 7/2025. Foster City, CA. Gilead Sciences. Accessed Aug 5, 2025 at https://www.gilead.com/~/media/files/pdfs/medicines/hiv/biktarvy/biktarvy_pi.pdf
- Biktarvy. Important Facts. Gilead.com. Feb 2024. Accessed Aug. 5, 2025 at https://services.gileadhiv.com/content/pdf/BIKTARVY/Important_Facts.pdf
Read next
Who are the actors in the Biktarvy commercials?
One actor and four real-life patients feature in the Biktarvy commercial “Keep loving who you are”, released on March 25th, 2020. They are Dimitri Moise, D’Eva Longoria, Zach [surname withheld], Nakeisa Jackson (Nikki), and Hugo [surname withheld]. The commercial was filmed at various locations including New York, Chicago, Atlanta, Cape May, and San Antonio. Continue reading
Does Biktarvy cause weight gain?
Weight gain is a side effect with Biktarvy, but it was reported after the drug was approved and it's not known if it was caused by the drug. Studies have shown a weight gain of between 1 and 4 kg (2.2 to 8.8 lbs) over 2 years with integrase inhibitors. Continue reading
Do you have to take Biktarvy forever?
Biktarvy antiretroviral therapy (ART) is taken indefinitely for HIV-1 infection as it is a complete regimen for long-term treatment. Stopping ART can increase blood levels of the HIV virus, lead to resistance, increase your risk for HIV infections and complications and increase the chance that you may transmit the infection to others.
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