
Treatment GuideJust DiagnosedSex & DatingAfrican AmericanStigmaAsk the HIV DocPrEP En EspañolNewsVoicesPrint IssueVideoOut 100
CONTACTCAREER OPPORTUNITIESADVERTISE WITH USPRIVACY POLICYPRIVACY PREFERENCESTERMS OF USELEGAL NOTICE
© 2025 Pride Publishing Inc.
All Rights reserved
All Rights reserved
By continuing to use our site, you agree to our Private Policy and Terms of Use.
When drugmakers Gilead and Bristol-Myers Squibb agreed to collaborate to create a three-drugs-in-one pill, Atripla was born. The holy grail of treating HIV with just one pill a day soon became a treatment of choice when starting patients on their first anti-HIV regimen. However, Atripla was not for everyone. Some patients could not tolerate the side effects of the efavirenz component, which gave some patients sleep problems, like uncomfortably vivid dreams or daytime drowsiness. Other patients were already resistant to efavirenz, since in some populations over 10% of transmitted HIV carries the efavirenz resistance mutation. Now it looks like the next all-in-one pill is on the way. Researchers presented data in February at the annual Conference on Retroviruses and Opportunistic Infections on a combination drug containing tenofovir plus emtricitabine (Truvada) combined with elvitegravir (a new integrase inhibitor) and cobicistat (a booster) -- since nicknamed the Quad. Note that this pill contains an integrase inhibitor instead of a nonnucleoside reverse transcriptase inhibitor, like efavirenz, so it will work when there is resistance. These drugs are all made by Gilead, which licensed elvitegravir from a Japanese company in 2005 for further development. Gilead then discovered that elvitegravir needed to be boosted with ritonavir to achieve effective blood levels, just like most protease inhibitors. So Gilead created cobicistat, which blocks a metabolic enzyme pathway in the liver similar to ritonavir. The CROI presentation was a Phase II trial comparing the Quad to Atripla in treatment-naive patients. The study showed that 90% of the Quad patients and 83% of the Atripla patients achieved viral loads below 50 at the 24-week point. This difference was not statistically significant. The study size of only 71 patients did not allow for formal efficacy comparisons, but the Quad did statistically meet the criteria for noninferiority. There were no significant differences in side effects between the two groups, other than the specific side effects of efavirenz mentioned above. Larger, Phase III trials are now just beginning. In an interesting and logical move, Gilead ran a parallel study comparing cobicistat to ritonavir as boosters in a standard combination of Reyataz plus Truvada. At 24 weeks 84% of patients on cobicistat had undetectable viral loads compared to 86% for those on ritonavir. Researchers had hoped that cobicistat might be better tolerated than ritonavir, but there were no significant differences in side effects, specifically nausea or diarrhea, or changes in blood lipids. Finally, researchers in the two studies had some concern that cobicistat might reduce kidney function, since the drug seemed to cause a small increase in creatinine. Further kidney clearance studies have shown, fortunately, that the kidney function remains intact, and the creatinine elevations are caused by cobicistat slightly slowing creatinine excretion by the kidney without impairment of total kidney function. It was a bright new day when the first all-in-one pill came out. It will be an even brighter day when I can tell my patients that we have a second option. Bowers is an HIV specialist and is board-certified in family medicine. He is in private practice in New York City. Learn more about him on his professional website.
From our Sponsors
Most Popular
Why activist Raif Derrazi thinks his HIV diagnosis is a gift
September 17 2024 12:00 PM
Out100 Honoree Tony Valenzuela thanks queer and trans communities for support in his HIV journey
September 18 2024 12:00 PM
How fitness coach Tyriek Taylor reclaims his power from HIV with self-commitment
September 19 2024 12:00 PM
Creator and host Karl Schmid fights HIV stigma with knowledge
September 12 2024 12:03 PM
Ricky Martin delivers showstopping performance for 2024 World AIDS Day
December 05 2024 12:08 PM
California confirms first case of even more deadly mpox strain
November 18 2024 3:02 PM
Eureka is taking a break from competing on 'Drag Race' following 'CVTW' elimination
August 20 2024 12:21 PM
Plus: Featured Video
Latest Stories
Celebrating Black History Month with our annual African American issue
February 01 2025 3:28 PM
Trump's orders prompt CDC to erase HIV resources
January 31 2025 5:29 PM
SFAF's Dr. Tyler TerMeer says he'll continue to fight for health care for all
January 28 2025 3:00 PM
Lexi Love goes public with HIV status after Trump wipes resources from federal website
January 23 2025 11:23 AM
Plus nominated for 2025 GLAAD Media Award alongside industry giants like Vogue, People, and Variety
January 22 2025 12:42 PM
A camp for HIV-positive kids is for sale. Here's why its founder is celebrating
January 02 2025 12:21 PM
This long-term HIV survivor says testosterone therapy helped save his life.
December 16 2024 8:00 PM
'RuPaul's Drag Race' star Trinity K Bonet quietly comes out trans
December 15 2024 6:27 PM
AIDS Memorial Quilt displayed at White House for the first time
December 02 2024 1:21 PM
Decades of progress, uniting to fight HIV/AIDS
December 01 2024 12:30 PM
Hollywood must do better on HIV representation
December 01 2024 9:00 AM
Climate change is disrupting access to HIV treatment
November 25 2024 11:05 AM
Post-election blues? Some advice from mental health experts
November 08 2024 12:36 PM
Check out our 2024 year-end issue!
October 28 2024 2:08 PM
Meet our Health Hero of the Year, Armonté Butler
October 21 2024 12:53 PM
AIDS/LifeCycle is ending after more than 30 years
October 17 2024 12:40 PM
Twice-yearly injectable lenacapavir, an HIV-prevention drug, reduces risk by 96%
October 15 2024 5:03 PM
Kentucky bans conversion therapy for youth as Gov. Andy Beshear signs 'monumental' order
September 18 2024 11:13 AM
Study finds use of puberty blockers safe and reversible, countering anti-trans accusations
September 11 2024 1:11 PM
Latinx health tips / Consejos de salud para latinos (in English & en espanol)
September 10 2024 4:29 PM