Combinational therapies for HIV: a focus on EVG/COBI/FTC/TDF.

INTRODUCTION: The co-formulation of elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate (EVG/COBI/FTC/TDF) is a new, investigational, once-daily (q.d.) drug, currently undergoing Phase II and III clinical trials. Next to the nucleotide/nucleoside reverse transcriptase inhibitors FTC and TDF, it contains EVG, the second member of the HIV-1 integrase strand transfer inhibitor class, together with its pharmacokinetic booster COBI.

AREAS COVERED: In this article, the authors review EVG/COBI/FTC/TDF, in addition to discussing the single-tablet regimens (STRs) containing EFV/FTC/TDF or RPV/FTC/TDF, and the investigational combination pill containing dolutegravir, lamivudine and abacavir (DTG/3TC/ABC, 572-Trii pill). A Medline review was conducted of Phase II and III trials, as well as a review of abstracts from major HIV and infectious disease conferences from 2010 to 2012, involving EVG/COBI/FTC/TDF.

EXPERT OPINION: Next to the combination of EFV/FTC/TDF or RPV/FTC/TDF, the co-formulation of EVG/COBI/FTC/TDF offers a new, q.d., single-tablet alternative in treatment-naïve HIV patients. EVG/COBI/FTC/TDF combines a high efficacy with a good tolerability profile. The effect on the renal function and virologic failure with the development of resistance to two or more compounds present in EVG/COBI/FTC/TDF, requires further monitoring. STRs certainly bring the standard for HIV treatment and drug development to a higher level.