Elvitegravir/cobicistat/emtricitabine/tenofovir

Elvitegravir/cobicistat/emtricitabine/tenofovir (brand name Stribild), also known as the Quad pill, is a fixed dose combination drug for the treatment of HIV/AIDS. Elvitegravir, emtricitabine and tenofovir directly suppress viral reproduction. Cobicistat increases the effectiveness of the combination by inhibiting the liver and gut wall enzymes that metabolize elvitegravir.

The drug is manufactured by Gilead Sciences. Stribild gained approval by U.S. Food and Drug Administration on August 27, 2012 for use in adult patients starting antiretroviral treatment for the first time as part of the fixed dose combination. Gilead's stated wholesale price of Stribild is $28,500 per patient, per year. Gilead maintains that Stribild pricing is comparable to other HIV medications on the market. Stribild is priced at 39 percent higher than Complera, a three-drug HIV regimen approved only one year ago. At the time of Complera's approval, there were concerns about the $20,500 wholesale cost of Atripla, which is marketed by Gilead and Bristol-Myers Squibb. HIV drug prices have increased substantially, even during the current economic downturn. Atripla, a combination therapy released in 2006 was priced at $13,800 per person, per year. Atripla's current wholesale prices have risen to the level of Complera's at $20,500. Rising drug costs and HIV cases, combined with tighter state budgets may burden the AIDS Drug Assistance Program (ADAP) to the breaking point. Kaiser Family Foundation reports that ADAP provided HIV drug benefit to 138,000 people in 2011, with a current waiting list totaling 2,030 HIV-positive individuals. Many states including California, Colorado, Georgia, and Virginia are considering measures to cut ADAP spending.

An increase in the serum creatinine level (a marker of kidney function) may increase with use of Stribild. This is caused by inhibition of tubular secretion of creatinine in the nephron by cobicistat. An increase of up to 0.3 mg/dL is expected; if serum creatinine level increases by 0.4 mg/dL or more, further evaluation for other causes of acute kidney injury is recommended.