Guides

Choice of integrase inhibitor (INSTI)

Dolutegravir and bictegravir

Dolutegravir (DTG) and bictegravir (BIC) are so similar that this choice will depend on which nukes you use.

They are also in these fixed dose combinations (FDCs).

About 1 in 20 people (5%) report mood changes or interrupted sleep. This is why it is better to taking these meds in the morning.

Weight gain has been reported as a side effect that might be higher with dolutegravir or bictegravir. It might also be higher in women compared to men.

Integrase inhibitors can interact with supplements that contain calcium, magnesium or aluminium. These can sometimes still be taken by separating the dosing times. See the prescribing leaflet for each drug.

Options for the two nukes

Other integrase inhibitors

There are three other integrase inhibitors.

  • raltegravir (RAL)
  • elvitegravir/cobicistat (EGV/c) – includes a booster drug.
  • cabotegravir (CAB-LA) – long-acting injection with rilpivirine-LA. This injectable treatment is only recommended after viral load has been undetectable for more than six months on oral ART.

These are also in these fixed dose combinations (FDCs).

Other notes

  • Dolutegravir and bictegravir are preferred because they have a a lower risk of drug resistance.
  • Dolutegravir can sometimes overcome early resistance to other INSTIs when it is used twice-daily.
  • The main drug interactions with INSTIs are with supplements that contain calcium, magnesium or aluminium. These interactions can be overcoome by separating the dosing times of ART and the supplements. Please see the prescribing leaflet for each drug.
  • The formulations for raltegravir involves taking two pills. Sometimes raltegravir is also dosed twice-daily.
  • Even though elvitegravir is boosted by cobicistat, it still need to be taken with food to get high enough doses.
  • Injectable ART is steadily being used by more people. It is a switch combination after oral treatment.

Last updated: 1 September 2024.