Which of the following agents for the management of HIV infection contain a pharmacokinetic enhancer? Select all that apply.
All options contain a pharmacokinetic enhancer. The management of HIV has changed tremendously over the years for the better, transitioning from patients taking many tablets multiple times daily to one tablet one time daily known as STRs or "Single Tablet Regimens". Knowledge of different pharmacologic classes of agents is important when determining which agents to use. Historically, ritonavir has been used in conjunction with protease inhibitors as a "booster" due to its ability to inhibit CYP 450 enzymes resulting in increased concentrations of an agent such as atazanavir or darunavir. While ritonavir has some antiviral activity, it is never used alone in the management of HIV due to decreased effectiveness. More recently, cobicistat, a pharmacokinetic enhancer, "boosts" levels of other HIV agents but does not itself have antiviral activity. All of the answer choices listed have cobicistat in them: Stribild (Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Disoproxil Fumarate); Evotaz (Atazanavir/Cobicistat); Genvoya (Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Fumarate); Symtuza (Darunavir/Cobicistat/Emtricitabine/Tenofovir Alafenamide); Prezcobix (Darunavir/Cobicistat).
Updates in the management of HIV happen often, much faster than other diseases. A fantastic resource for learning about HIV medications as well as the most recent updated guidelines can be found here: https://aidsinfo.nih.gov/