When Biktarvy Isn't Available, What Are Your Options?

Biktarvy (bictegravir/emtricitabine/tenofovir alafenamide) is the most prescribed HIV treatment in the United States — and for good reason. It's effective, well-tolerated, and comes in a single daily pill. But what happens when you can't find it at your pharmacy?

First, the most important rule: never stop your HIV treatment or switch medications on your own. Always work with your healthcare provider. That said, it's helpful to understand what alternatives exist so you can have an informed conversation with your doctor.

What Is Biktarvy and How Does It Work?

Biktarvy is a complete antiretroviral regimen in one pill. It contains three medications:

• Bictegravir — an integrase strand transfer inhibitor (INSTI) that prevents HIV from inserting its DNA into your cells
• Emtricitabine — a nucleoside reverse transcriptase inhibitor (NRTI) that blocks HIV from copying itself
• Tenofovir alafenamide (TAF) — another NRTI that also blocks viral replication, with improved kidney and bone safety compared to older forms of tenofovir

Together, these three drugs attack HIV at multiple points in its life cycle, bringing viral load to undetectable levels in most patients within weeks. Biktarvy is taken once daily, with or without food, and is approved for adults and children weighing at least 31 pounds.

Alternative HIV Treatments to Discuss With Your Doctor

If you can't find Biktarvy, your doctor may consider one of the following alternatives. Each has its own advantages and considerations.

1. Dovato (Dolutegravir/Lamivudine)

Manufacturer: ViiV Healthcare
Type: Two-drug, single-tablet regimen
How it works: Dovato combines dolutegravir (an INSTI, similar to bictegravir) with lamivudine (an NRTI). It's one of the few FDA-approved two-drug regimens for HIV treatment.

Key points:

• Taken once daily with or without food
• May be an option for patients who are treatment-naïve or virologically suppressed
• Fewer active ingredients may mean fewer potential side effects
• Not appropriate for patients co-infected with hepatitis B (lamivudine alone doesn't fully treat HBV)

2. Triumeq (Dolutegravir/Abacavir/Lamivudine)

Manufacturer: ViiV Healthcare
Type: Three-drug, single-tablet regimen
How it works: Triumeq combines dolutegravir (INSTI) with abacavir and lamivudine (both NRTIs).

Key points:

• Taken once daily
• Requires HLA-B*5701 testing before starting — patients who test positive cannot take abacavir due to risk of a serious hypersensitivity reaction
• Long track record of efficacy
• Not ideal for patients with hepatitis B co-infection

3. Symtuza (Darunavir/Cobicistat/Emtricitabine/Tenofovir Alafenamide)

Manufacturer: Janssen
Type: Four-drug, single-tablet regimen
How it works: Symtuza uses a different drug class backbone — a protease inhibitor (darunavir) boosted by cobicistat, plus two NRTIs.

Key points:

• Taken once daily with food
• Must be taken with food for proper absorption
• Good option for patients who may have INSTI resistance
• Higher pill burden equivalent (4 active ingredients) but still one pill
• More drug interactions due to cobicistat boosting

4. Cabenuva (Cabotegravir/Rilpivirine) — Injectable Option

Manufacturer: ViiV Healthcare
Type: Long-acting injectable regimen
How it works: Cabenuva is a two-drug combination given as injections by a healthcare provider — either monthly or every two months. It replaces daily oral pills entirely.

Key points:

• No daily pills — injections are given in a healthcare setting
• Requires an oral lead-in period (1 month of oral cabotegravir + rilpivirine) before starting injections
• Only for patients already virologically suppressed with no history of treatment failure
• Not affected by pharmacy stock issues in the same way as oral medications
• May not be suitable for all patients

How to Choose the Right Alternative

The best alternative depends on your individual situation, including:

• Your treatment history and any prior resistance testing results
• Hepatitis B co-infection status
• HLA-B*5701 status (for abacavir-containing regimens)
• Kidney and liver function
• Other medications you take (drug interactions vary by regimen)
• Your preference for daily pills vs. injections
• Insurance coverage and cost

Your doctor has all of this information and can recommend the best option for you. Don't make changes to your HIV treatment without medical guidance.

Before Switching: Try to Find Biktarvy First

Switching medications should be a last resort if Biktarvy is working well for you. Before your doctor considers alternatives, try these steps:

• Use Medfinder to locate pharmacies with Biktarvy in stock
• Try independent or specialty pharmacies
• Contact Gilead Advancing Access at 1-800-226-2056
• Ask about mail-order pharmacy options

For more tips, see our guide on how to find Biktarvy in stock near you.

Final Thoughts

Biktarvy is an excellent HIV treatment, but it's not the only option. If you can't find it, effective alternatives like Dovato, Triumeq, Symtuza, and Cabenuva exist. The most important thing is to stay on treatment — work with your healthcare provider to find the best solution for your situation.

Related reading: What is Biktarvy? | How does Biktarvy work? | Biktarvy drug interactions