Cobicistat + elvitegravir + emtricitabine + tenofovir. Two new drugs, but no progress.

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.