Elvitegravir: a review of its use in adults with HIV-1 infection

The HIV integrase inhibitor elvitegravir is now available as a single-agent tablet (Vitekta(®)) in the EU, where it is indicated for once-daily oral use, in combination with a ritonavir-boosted protease inhibitor (PI) and other antiretrovirals, for the treatment of HIV-1 infection in adults without known mutations associated with resistance to elvitegravir. The drug has potent anti-HIV activity and a well characterized resistance profile, although cross resistance with raltegravir is observed. When used in combination with ritonavir-boosted PI-based antiretroviral therapy (ART) in treatment-experienced adults in a randomized, double-blind, phase III trial, once-daily elvitegravir was associated with virological suppression noninferior to that seen with twice-daily raltegravir after 48 weeks' treatment, and such benefits were largely maintained at 96 weeks. Moreover, in an open-label extension of this study, in which all patients received an elvitegravir regimen, virological suppression continued to be observed in most patients at 144 weeks. Elvitegravir is generally well tolerated, with diarrhoea and nausea being the most common tolerability issues. Thus, single-agent elvitegravir extends the treatment options available for use in the ritonavir-boosted PI-based ART regimens of adults infected with HIV-1 and has the convenience of once-daily administration.