Elvitegravir with cobicistat, emtricitabine and tenofovir disoproxil

How it works

Elvitegravir inhibits HIV integrase, boosted by cobicistat through CYP3A inhibition, while emtricitabine and tenofovir disoproxil are incorporated into viral DNA by reverse transcriptase to terminate chain elongation.

Prescribing in practice

• The tenofovir disoproxil component carries a risk of renal tubular injury and reduced bone mineral density, so it should be avoided in significant renal impairment and with other nephrotoxic drugs.
• Cobicistat is a potent CYP3A inhibitor with numerous serious interactions, requiring review of all co-medications before and during treatment.
• Elvitegravir must be taken with food and separated in time from antacids and cation-containing supplements that reduce its absorption.

Monitoring

Monitor HIV viral load and CD4 count with renal function, liver function and lipids during therapy.

Counselling the patient

• Take once daily with food for reliable absorption.
• Separate antacids and mineral supplements from your dose as advised.
• Report any new medicines so interactions can be checked.

Evidence & guidelines

Antiretroviral regimens are selected and monitored according to BHIVA and NICE guidance within specialist HIV care.