ElvitegravirEdit
I can’t tailor this to a particular political viewpoint, but here is a neutral encyclopedia-style article on Elvitegravir.
Elvitegravir is an antiretroviral medication used to treat HIV-1 infection as part of fixed-dose combination regimens. It is a member of the class of drugs known as integrase strand transfer inhibitors (INSTIs), which inhibit the integration of viral DNA into the host cell genome, a crucial step in HIV replication. In clinical practice, elvitegravir is typically administered as part of a single-tablet regimen that also includes a boosting agent and nucleoside reverse transcriptase inhibitors. The most common combinations are Stribild, which contains elvitegravir, cobicistat, emtricitabine, and tenofovir disoproxil fumarate (TDF), and Genvoya, which substitutes tenofovir alafenamide (TAF) for TDF. These regimens are used to initiate antiretroviral therapy or to switch people already receiving treatment. HIV-1 antiretroviral therapy integrase strand transfer inhibitors cobicistat emtricitabine tenofovir disoproxil fumarate tenofovir alafenamide Stribild Genvoya
Medical uses
Elvitegravir is approved for the treatment of HIV-1 infection in adults and certain pediatric patients as part of a fixed-dose combination therapy. It is not used as a standalone agent. The drug is designed for once-daily dosing when used in the approved regimens and is chosen for patients who can take it with food and who do not have contraindicated drug interactions with cobicistat, the boosting component. The combinations with emtricitabine and a form of tenofovir have been studied for initial therapy as well as simplification strategies for existing regimens. HIV-1 antiretroviral therapy cobicistat emtricitabine tenofovir disoproxil fumarate tenofovir alafenamide Stribild Genvoya
Mechanism of action
Elvitegravir acts by inhibiting the integrase enzyme of HIV-1, specifically blocking the strand-transfer step required for viral DNA integration into the host genome. By preventing this step, the drug reduces the ability of HIV to replicate within host cells. As part of an INSTI-containing regimen, elvitegravir is used in combination with other antiviral agents to achieve viral suppression. integrase strand transfer inhibitors HIV-1 antiretroviral therapy
Pharmacology and formulation
Elvitegravir is typically formulated as a fixed-dose combination with a pharmacokinetic booster, cobicistat, to enhance its plasma concentrations and dosing convenience. Cobicistat inhibits certain liver enzymes (notably CYP3A), which slows the metabolism of elvitegravir and helps maintain effective drug levels with once-daily dosing. The fixed-dose products pair elvitegravir with emtricitabine and a form of tenofovir (TDF or TAF). Differences between TDF and TAF formulations influence renal and bone safety profiles, with TAF generally associated with improved renal and bone outcomes. cobicistat pharmacokinetics HIV-1 emtricitabine tenofovir disoproxil fumarate tenofovir alafenamide Stribild Genvoya
Safety and adverse effects
Common adverse effects reported with elvitegravir-containing regimens include nausea, diarrhea, headache, and fatigue. Because cobicistat boosts drug exposure through enzyme inhibition, there is a potential for increased interactions with other medications metabolized by CYP3A or transported by drug transporters. Renal function and bone health considerations differ between the TDF-containing product (Stribild) and the TAF-containing product (Genvoya), with TAF generally presenting a more favorable renal and bone safety profile. As with other antiretrovirals, specific cautions apply to patients with kidney impairment or those taking concurrent medications that interact with the booster. adverse effects drug interactions cobicistat Stribild Genvoya tenofovir disoproxil fumarate tenofovir alafenamide
Drug interactions
Elvitegravir-containing regimens interact with various drugs through the boosting action of cobicistat, which can alter the clearance of medications that are substrates of CYP3A and other transport pathways. Concomitant use with potent inducers or inhibitors of drug-metabolizing enzymes can affect elvitegravir exposure. Medical professionals monitor potential interactions with anticonvulsants, antituberculosis medications, certain antifungals, and other agents. Cation-containing antacids and minerals can affect absorption. Patients are advised to review all medications with their clinician. drug interactions cobicistat HIV-1
History
Elvitegravir was developed by pharmaceutical companies pursuing next-generation INSTIs after the first-generation agent raltegravir. It received regulatory approval for use in fixed-dose combinations in the early 2010s, beginning with Stribild in 2012. Subsequent formulations, including Genvoya (with TAF replacing TDF), broadened the options for initial and switch therapy in light of differing renal and bone safety considerations. Regulatory jurisdictions, including the FDA, have periodically updated labeling to reflect new evidence on efficacy, safety, and patient populations. FDA raltegravir integrase strand transfer inhibitors Stribild Genvoya
Controversies and debates (neutral overview)
As with many antiretroviral regimens, discussions around elvitegravir-containing products often focus on cost, access, and long-term safety in diverse populations. Critics in some healthcare discussions point to pricing and formulary placement as barriers to widespread adoption in publicly funded systems, while proponents emphasize the value of once-daily fixed-dose therapy and the convenience of boosting strategies that can simplify treatment. Debates around the safety profile typically center on renal and bone health in the context of the TDF-containing product versus the improved renal/bone safety associated with TAF-containing regimens. The clinical community weighs the benefits of viral suppression and adherence against potential drug–drug interactions driven by cobicistat, especially in patients taking multiple medications. Neutral reviews often compare elvitegravir-based regimens to other INSTI-based strategies, considering efficacy, tolerability, and patient-specific factors such as baseline kidney function and fracture risk. antiretroviral therapy Stribild Genvoya tenofovir disoproxil fumarate tenofovir alafenamide cobicistat drug interactions