title: Tenofovir alafenamide, emtricitabine, elvitegravir, and cobicistat combination therapy for the treatment of HIV.
abstract: Tenofovir alafenamide (TAF) is a novel prodrug of the nucleotide analogue reverse-transcriptase inhibitor, tenofovir. TAF has been co-formulated with emtricitabine (FTC), elvitegravir (EVG) and the EVG metabolic enhancer, cobicistat (COBI) as a single-tablet regimen being the first TAF-containing antiretroviral combination available. Areas covered: This article summarizes the available information on the pharmacology of the novel compound TAF and overviews TAF/FTC/EVG/COBI use for HIV-1 infected patients, with specific focus on clinical efficacy and safety data. Information sources include peer-reviewed scientific literature, conference proceedings and publically available regulatory reports. Compared to tenofovir disoproxil fumarate, TAF results in higher concentrations of the active metabolite tenofovir diphosphate within lymphoid cells, whereas plasma tenofovir exposure is about 90% lower. The efficacy and safety of TAF/FTC/EVG/COBI in treatment-naïve HIV-infected patients has been assessed in phase-III randomized trials, showing non-inferior virological suppression in comparison with TDF/FTC/EVG/COBI, and significantly lower renal and bone toxicity. In addition, TAF/FTC/EVG/COBI has demonstrated efficacy and safety as a switching strategy in suppressed HIV-1 infected individuals, including those with mild or moderate renal impairment. Expert commentary: Approval of the single-tablet TAF/FTC/EVG/COBI regimen is an important advance in HIV therapy, as it is associated with very high efficacy and a better kidney and bone safety profile compared to TDF-containing regimens due to the incorporation of TAF.
authors.affiliation: a HIV and STD Unit, Department of Infectious Diseases , Bellvitge University Hospital, Bellvitge Biomedical Research Institut (IDIBELL) , Barcelona , Spain.
authors.forename: Arkaitz
authors.initials: A
authors.lastname: Imaz
authors.affiliation: a HIV and STD Unit, Department of Infectious Diseases , Bellvitge University Hospital, Bellvitge Biomedical Research Institut (IDIBELL) , Barcelona , Spain.
authors.forename: Daniel
authors.initials: D
authors.lastname: Podzamczer
mesh_terms: D019380:Anti-HIV Agents / Q000494:pharmacology / Q000627:therapeutic use*; D017321:Clinical Trials, Phase I as Topic; D017322:Clinical Trials, Phase II as Topic; D017326:Clinical Trials, Phase III as Topic; D000069547:Cobicistat / Q000494:pharmacology / Q000627:therapeutic use*; D004338:Drug Combinations; D004347:Drug Interactions; D000068679:Emtricitabine / Q000494:pharmacology / Q000627:therapeutic use*; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D015363:Quinolones / Q000494:pharmacology / Q000627:therapeutic use*; D000068698:Tenofovir / Q000494:pharmacology / Q000627:therapeutic use*
chemical_list: D019380:Anti-HIV Agents; D004338:Drug Combinations; D015363:Quinolones; C509700:elvitegravir; D000068698:Tenofovir; D000068679:Emtricitabine; D000069547:Cobicistat
keywords: HIV-1 infection; Tenofovir alafenamide; antiretroviral therapy; cobicistat; elvitegravir