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Treatment-Emergent Bictegravir Resistance in a Treatment-Naive Individual With HIV Infection: A Case Report

Year: 2026

Type: article

Abstract: Bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) is a highly potent antiretroviral regimen with a high genetic barrier to resistance. Clinical trials have not reported treatment-emergent resistance in treatment-naive individuals. We describe a rare case of virologic failure with an emergent R263K integrase mutation in a treatment-naïve, adherent individual maintained on BIC/FTC/TAF. The patient achieved initial suppression for nearly two years before rebound viremia with R263K and D67N mutations. Following the regimen change and treatment of concurrent syphilis, viral suppression was re-established. This case highlights that emergent bictegravir resistance can occur in adherent, treatment-naïve patients, emphasizing the importance of continued resistance monitoring.

Source: Cureus

DOI: 10.7759/cureus.106218

Authors: Iya Dubson, Aahana Gaur, Jasmin Jose, Charles Andrews, Andrew Gaballa, Samy I McFarlane

Institutions: VA NY Harbor Healthcare System, SUNY Downstate Health Sciences University

Language: English

Topic: HIV/AIDS drug development and treatment

Subfield: Infectious Diseases

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond

OpenAlex ID: W7146955208