title: Cobicistat + elvitegravir + emtricitabine + tenofovir. Two new drugs, but no progress.
abstract: First-line treatment of HIV-1 infection currently consists of a combination of at least three antiretroviral drugs belonging to two different classes: for example, efavirenz + tenofovir + emtricitabine or lopinavir + ritonavir + tenofovir + emtricitabine. Following marketing authorisation in the United States, a marketing application has been submitted in the European Union for the fixed-dose combination of cobicistat (CYP 3A inhibitor), elvitegravir (HIV integrase inhibitor), emtricitabine and tenofovir (HIV reverse transcriptase inhibitors). Clinical evaluation is based on two "non-in feriority" trials, one versus efavirenz + emtricitabine + tenofovir, and the other versus atazanavir+ ritonavir + emtricitabine + tenofovir. Overall, about 85% of patients achieved undetectable viral load 48 weeks after treatment initiation. The cobicistat + elvitegravir + emtricitabine + tenofovircombination had the usual adverse effects of antiretroviral combinations (diarrhoea, nausea, upper respiratory tract infections, neuropsychological disorders, etc.), plus musculoskeletal disorders and renal toxicity. Cobicistat carries a high risk of interactions. The cobicistat + elvitegravir + emtricitabine + tenofovir combination is taken as a single daily tablet. In practice, given the lack of therapeutic progress, it is best to stick with better-documented antiretroviral combinations.
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy*; D000225:Adenine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000009:adverse effects*; D002219:Carbamates / Q000008:administration & dosage / Q000009:adverse effects; D000069547:Cobicistat; D003841:Deoxycytidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D004359:Drug Therapy, Combination; D000068679:Emtricitabine; D015497:HIV-1 / Q000187:drug effects*; D006801:Humans; D063065:Organophosphonates / Q000008:administration & dosage / Q000009:adverse effects; D015363:Quinolones / Q000008:administration & dosage / Q000009:adverse effects; D000068698:Tenofovir; D013844:Thiazoles / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D019380:Anti-HIV Agents; D002219:Carbamates; D063065:Organophosphonates; D015363:Quinolones; D013844:Thiazoles; D003841:Deoxycytidine; C509700:elvitegravir; D000068698:Tenofovir; D000068679:Emtricitabine; D000225:Adenine; D000069547:Cobicistat