What is Stribild Used For
Stribild is an antiretroviral therapy (ART) which combines four HIV medications in one pill. This complete single-tablet regimen (STR) contains elvitegravir (EVG), cobicistat (COBI), emtricitabine (FTC), and tenofovir disoproxil fumarate (TDF). As with all currently available ART in the market, Stribild does not cure HIV, but it helps prevent the virus from reproducing and injecting themselves into host cells—CD4 T-cells of the immune system. Without antiretroviral therapies, HIV can proliferate the cells of the immune system and compromise the body’s defense against foreign stressors and infectious agents. Acquired Immune Deficiency Syndrome (AIDS) is the advanced stage of HIV, which usually occurs when the person’s immune system is severely weakened by the virus.
FDA approval and certification
Stribild was granted FDA approval in August 2012 to treat HIV-1 infection in people 12 years and older who weight at least 35 kilograms (77 pounds). People who have never started treatment or people who are replacing their current HIV regimen can use Stribild.
This guide does not include all the necessary information on taking Stribild. For your safety, always discuss symptoms and side effects with your health care provider (HCP), and do not change the prescribed dose without consulting your HCP. For a full list of adverse events and warnings, please refer to the manufacturer’s website and FDA guideline.
How it works
Human Immunodeficiency virus (HIV) affects the body’s immune system by attacking immune cells and creating multiple copies of itself to invade more cells. People with high viral load can easily transmit the virus to other people, although anyone with HIV is at risk of passing the virus to non-infected individuals, regardless of their viral load.
The four active drugs in Stribild work synergistically to prevent the virus from multiplying and attacking the immune cells. HIV needs certain enzymes, such as integrase and reverse transcriptase, to penetrate the surfaces of the immune cells. Emtricitabine and tenofovir block the action of reverse transcriptase, while elvitegravir inhibits the enzyme integrase. The addition of cobicistat is to enhance the effect of these drugs by keeping them longer in the body.
Safety and Efficacy
Two pivotal studies led by the makers of Stribild, Gilead Sciences, showed that a three-year course of treatment with Stribild has comparable efficacy to Atripla and Truvada. Out of 348 patients in Study 102, 279 or 80% achieved a viral load of less than 50 copies/ml versus the 75% from the Atripla group. In Study 103, 78% patients on Stribild achieved a viral load of less than 50 copies/ml versus 75% from Truvada group. Common side effects reported include nausea, diarrhea, and headache.
Things to know before taking Stribild
Good Candidates for Treatment
You are a good candidate for this regimen if you have not received treatment before or if you want to switch to a new ART, provided that:
- you have a viral load of <50 copies/ml;
- you are on the same regimen for the last 6 months;
- you have not experienced resistance from any of the drugs included in Stribild.
You should not take Stribild if you are also infected by hepatitis B (HBV) virus, as it can worsen your condition.
Warnings and Contraindications
- You should not take this regimen if you have a history of allergic reaction to elvitegravir (EVG), cobicistat (COBI), emtricitabine (FTC), or tenofovir disoproxil fumarate (TDF).
- Stribild can cause worsening of hepatitis B in patients infected with both HIV-1 and HBV
- Two components of this regimen (TDF and FTC) can induce lactic acid buildup in the blood, liver enlargement, and fatty liver.
- TDF is associated with slightly greater decrease in bone mineral density and mineralization defects.
- Immune reconstitution syndrome is a common possible complication among patients treated with combination ART.
How to take Stribild
Each tablet of Stribild contains 150mg of elvitegravir (EVG), 150mg of cobicistat (COBI), 200mg of emtricitabine (FTC), and 300mg of tenofovir disoproxil fumarate (TDF). Take one tablet daily, or as prescribed by your doctor. You should not take Stribild if your creatinine clearance is < 70ml/min or if it has declined below 50ml/min while on medication. Consult your health care provider before modifying the dose you are taking or if you have taken more than what is prescribed.
There are more than 60 drugs that should not be combined with Stribild and additional 33 drugs that can cause serious drug interactions. It should not be used together with other antiretroviral treatment. This medication can alter the concentration of drugs that are metabolized by CYP3A and CYP2D6 enzymes. Antacids can reduce the elimination of Stribild’s elvitegravir; take these medications at least two hours apart. Some drugs that can cause serious or life-threatening drug interactions include:
- Anti-asthma drugs;
- St. John’s wort supplement;
- Statins or cholesterol lowering drugs;
- Anti-tuberculosis drugs (rifampin);
- Anti-anxiety drugs.