cobicistat + elvitegravir + emtricitabine + tenofovir disoproxil fumarate at a glance
Medicine class
Integrase inhibitor plus two reverse-transcriptase inhibitors and a pharmacokinetic enhancer.
Main role
Complete fixed-dose treatment for selected people with HIV-1.
Food
Take with food to support absorption.
Kidneys and bones
Tenofovir disoproxil can affect renal tubules and bone mineral density, so assessment and monitoring are important.
What is cobicistat + elvitegravir + emtricitabine + tenofovir disoproxil fumarate used for?
UK-licensed uses include:
HIV-1 in adults who have not previously received antiretroviral treatment, or whose virus has no known resistance mutations affecting the components.
HIV-1 in adolescents aged 12 to under 18 years who weigh at least 35 kg, have no relevant known resistance mutations, and cannot use certain other regimens because of toxicities.
How does cobicistat + elvitegravir + emtricitabine + tenofovir disoproxil fumarate work?
Elvitegravir blocks HIV integrase, preventing viral DNA from being inserted into human-cell DNA. Emtricitabine and tenofovir block reverse transcriptase and terminate viral DNA formation. Cobicistat inhibits CYP3A metabolism, increasing and sustaining elvitegravir exposure; it has no direct anti-HIV activity.
How to take cobicistat + elvitegravir + emtricitabine + tenofovir disoproxil fumarate
Follow the HIV specialist’s instructions and take the tablet with food. Swallow it whole; do not chew or crush it.
Mineral-containing antacids, laxatives, supplements and multivitamins can interfere with absorption; ask the HIV team or pharmacist how to separate them.
Do not stop or restart treatment without speaking to the HIV team, particularly if you also have hepatitis B.
cobicistat + elvitegravir + emtricitabine + tenofovir disoproxil fumarate side effects
Common or expected effects
- Nausea, vomiting or diarrhoea
- Headache or dizziness
- Rash
- Weakness or tiredness
- Abdominal discomfort, indigestion, bloating or constipation
- Reduced appetite
- Insomnia or abnormal dreams
- Changes in kidney, liver, glucose, lipid or phosphate test results
Get urgent medical advice
- Swelling of the face, lips, tongue or throat suggesting angioedema
- Possible lactic acidosis
- Kidney injury or renal-tubule dysfunction, sometimes with weakness, bone pain or fractures
- Pancreatitis with significant persistent abdominal pain
- New or worsening inflammation, infection or autoimmune symptoms
- Severe hepatitis flare after stopping treatment in someone with HIV and hepatitis B
cobicistat + elvitegravir + emtricitabine + tenofovir disoproxil fumarate in pregnancy
This combination should not be started during pregnancy because cobicistat and elvitegravir exposure falls, risking loss of HIV control. Anyone who becomes pregnant or plans pregnancy should promptly contact their HIV team for specialist review rather than stopping treatment themselves.
cobicistat + elvitegravir + emtricitabine + tenofovir disoproxil fumarate while breastfeeding
The UK product information says this combination should not be used while breastfeeding. Emtricitabine and tenofovir enter breast milk, information for the other components is insufficient, and HIV can be transmitted through breast milk. Discuss infant feeding with the specialist HIV and maternity team.
cobicistat + elvitegravir + emtricitabine + tenofovir disoproxil fumarate interactions
Cobicistat causes numerous clinically important interactions. Check prescribed, over-the-counter and herbal products with the HIV team or pharmacist.
Rifampicin, carbamazepine, phenobarbital, phenytoin or St John’s wort
Can markedly reduce elvitegravir and cobicistat exposure, risking treatment failure and resistance; use is contraindicated.
Simvastatin or lovastatin
Cobicistat can greatly increase statin exposure and toxicity; use is contraindicated.
Mineral antacids, supplements, multivitamins, sucralfate or buffered products
Magnesium, aluminium, calcium, iron or zinc can reduce elvitegravir absorption.
Common questions about cobicistat + elvitegravir + emtricitabine + tenofovir disoproxil fumarate
Answers are fully visible for fast scanning and source review.
Why does this combination contain cobicistat?
Cobicistat slows CYP3A-mediated breakdown of elvitegravir, maintaining its exposure. It does not directly inhibit HIV.
Must it be taken with food?
Yes. Food increases exposure to elvitegravir and tenofovir and is required by the product information.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.