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?
• What if I miss a dose of Biktarvy?
• Does Biktarvy cause weight gain?

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.

Read next

See also:

Related medical questions

• What is the generic name for Biktarvy?
• What is the difference between Biktarvy and Descovy?
• Can you crush Biktarvy tablets?
• Does Biktarvy increase cholesterol?
• Does Biktarvy cause acne?
• Is Biktarvy a protease inhibitor?
• How fast or how long does it take Biktarvy to work?
• Can Biktarvy be used for PrEP or PEP?
• Who are the actors in the Biktarvy commercials?
• Does Dovato cause weight gain?
• Is Biktarvy an immunosuppressant?
• Who is eligible for the Biktarvy Copay Card?
• What is Biktarvy used for?

Drug information

• Bictegravir / emtricitabine / tenofovir Alafenamide (230 reviews)
• Biktarvy (227 reviews)

Related support groups

• Bictegravir/emtricitabine/tenofovir Alafenamide (14 questions, 3 members)
• Biktarvy (27 questions, 29 members)
• HIV Infection (99 questions, 250 members)
• Alopecia (64 questions, 138 members)

Medical Disclaimer