The University of Toledo Translation Journal of Medical Sciences 
Internal Medicine Abstract, Department of Medicine Research Symposium UTJMS 2023 May 5; 11(1):e1-e1 

Bictegravir, Emtricitabine & Tenofovir 
Alafenamide-associated Acute Pancreatitis 
Abdulmajeed Alharbi MD1*, Caleb Spencer MD1, Abdulaziz Aldhafeeri MD1, 
Nezam Altorok MD2

1Division of Internal Medicine, Department of Medicine, The University of Toledo, 
Toledo, OH 43614 
2Division of Rheumatology, Department of Medicine, The University of Toledo, 
Toledo, OH 43614 

*Corresponding author: Abdulmajeed.Alharbi@utoledo.edu

Published: 05 May 2023 

Background: Bictegravir, Emtricitabine & Tenofovir alafenamide (Biktarvy) is now considered as the 
first line treatment for Human Immunodeficiency virus (HIV). 

Case Report: Thirty-six year old male with history of Human Immunodeficiency Virus (HIV) on 
antiretroviral Bictegravir, Emtricitabine, and Tenofovir alafenamide (Biktarvy) presented to the 
emergency room complaining of constant sharp epigastric pain for 2 days associated with nausea and 
one episode of non-bloody vomit. Patient has no history of gallbladder stones, and he drinks alcohol 
socially. No family history of hypertriglyceridemia. In the emergency room patient was tachycardic at 
125 beats/minute, and blood pressure was 110/73 mmHg. Physical examination was remarkable for 
epigastric tenderness without rigidity. The underlying etiology was believed to be secondary to Biktarvy 
use since the patient was started 3 months prior to his presentation, Naranjo score is 6. Patient admitted 
to the regular floor, Biktarvy was discontinued, intravenous lactated ringer started at 150 mL/hour and 
diet status was nothing by mouth (NPO). Twenty-four hours after admission, patient condition markedly 
improved and his pain was controlled with intravenous hydromorphone 1 mg as needed.  On the fifth 
day of admission, the patient’s abdominal pain completely resolved, and he was able to tolerate regular 
diet. 

Conclusion: Prompt discontinuation of the offending agent is an essential part of treatment plan of acute 
pancreatitis, as seen in this patient. Healthcare providers should be aware of the unusual adverse event of 
Bictegravir, Emtricitabine, and Tenofovir alafenamide (Biktarvy) as a potential cause of pancreatitis in 
patients with Human Immunodeficiency Virus (HIV). 

https://dx.doi.org/10.46570/utjms.vol11-2023-688 

https://dx.doi.org/10.46570/utjms.vol11-2023-688
mailto:Abdulmajeed.Alharbi@utoledo.edu