HIV-1 Virologic Rebound Due to Coadministration of Divalent Cations and Bictegravir.

A potential drug-drug interaction exists between divalent and trivalent cations (Ca, Fe, Mg, Al, Zn) and HIV-1 integrase strand transfer inhibitors (INSTIs). There are limited case reports describing the clinical significance of this potential interaction and none to our knowledge identifying zinc co-administration with INSTIs. In this report we present a patient taking bictegravir/emtricitabine/tenofovir alafenamide who became viremic after ingesting zinc and calcium supplements and later was able to obtain virologic re-suppression after discontinuing supplements.