Stribild 150 mg/150 mg/200 mg/245 mg film-coated tablets

Stribild 150 mg/150 mg/200 mg/245 mg Film-Coated Tablets is a combination antiretroviral medication used in the treatment of HIV-1 infection in adults and adolescents aged 12 years and older. This medication contains four active ingredients: elvitegravir (150 mg), cobicistat (150 mg), emtricitabine (200 mg), and tenofovir disoproxil fumarate (245 mg). Together, these ingredients work to control HIV infection, improving immune function and reducing the risk of developing AIDS.

How Stribild Works

Mechanism of Action:

Stribild is a fixed-dose combination of four antiretroviral agents that target different stages of the HIV-1 replication cycle. Here’s how each component works:

1. Elvitegravir (150 mg):
   • Elvitegravir is an integrase strand transfer inhibitor (INSTI) that blocks the HIV integrase enzyme. This enzyme is responsible for integrating the viral DNA into the host cell’s DNA, a crucial step in the HIV replication process. By inhibiting integrase, elvitegravir prevents the virus from replicating and spreading to new cells.
2. Cobicistat (150 mg):
   • Cobicistat is a pharmacokinetic enhancer (also known as a booster). It has no direct antiviral activity but enhances the effectiveness of elvitegravir by inhibiting the enzymes that metabolize it, particularly CYP3A4. This inhibition increases the plasma concentration of elvitegravir, allowing it to remain in the bloodstream longer and at higher levels.
3. Emtricitabine (200 mg):
   • Emtricitabine is a nucleoside reverse transcriptase inhibitor (NRTI) that mimics the natural nucleotides used by the HIV reverse transcriptase enzyme. When incorporated into the viral DNA during replication, it causes chain termination, preventing the virus from replicating its genetic material.
4. Tenofovir Disoproxil Fumarate (245 mg):
   • Tenofovir disoproxil fumarate is another NRTI that also targets the reverse transcriptase enzyme. Like emtricitabine, it causes chain termination when incorporated into the viral DNA, further inhibiting the replication of HIV.

Combined Effect:

By targeting multiple stages of the HIV life cycle, Stribild effectively reduces viral load (the amount of HIV in the blood) and increases CD4 cell counts (a type of white blood cell important for immune function). This dual action helps to suppress the virus, improve immune function, and prevent the progression of HIV to AIDS.

Side Effects

While Stribild is generally well-tolerated, it can cause side effects in some patients. It is important for patients to be aware of potential side effects and to discuss any concerns with their healthcare provider.

Common Side Effects:

• Nausea
• Diarrhea
• Headache
• Dizziness
• Fatigue
• Insomnia
• Rash

Serious Side Effects:

• Lactic Acidosis: A rare but serious condition where lactic acid builds up in the blood, causing symptoms like weakness, fatigue, and stomach pain.
• Liver Problems: Including jaundice (yellowing of the skin and eyes), dark urine, and elevated liver enzymes.
• Kidney Problems: Including acute kidney injury and increased creatinine levels, particularly with long-term use.
• Bone Density Loss: Decreased bone mineral density, which can increase the risk of fractures.
• New or Worsening Kidney Problems: Particularly in patients with pre-existing kidney conditions.

Indications

Stribild is indicated for the treatment of HIV-1 infection in specific populations.

Approved Indications:

• Treatment of HIV-1 Infection: Stribild is indicated as a complete regimen for the treatment of HIV-1 infection in adults and adolescents aged 12 years and older who weigh at least 35 kg. It is not recommended for use in combination with other antiretroviral agents.

Contraindications

There are several conditions and situations where Stribild should not be used.

Contraindications:

• Hypersensitivity: Stribild is contraindicated in patients with a known hypersensitivity to any of its components.
• Severe Liver Impairment: Patients with severe liver impairment (Child-Pugh Class C) should not use Stribild due to the risk of drug accumulation and toxicity.
• Concurrent Use with Certain Drugs: Stribild should not be used with certain medications that are potent CYP3A inducers, such as rifampin, carbamazepine, and phenytoin, as these can significantly reduce the plasma concentrations of elvitegravir and lead to treatment failure.

Price in Different Countries

The cost of Stribild can vary depending on the country, healthcare system, and insurance coverage. Below is a table showing the approximate price of Stribild in various countries.

Country	Price (Per Unit)	Reference
United States	$2,500 – $3,000	GoodRx
United Kingdom	£1,800 – £2,100	NHS UK
Canada	CAD $2,700 – $3,200	DrugBank
Australia	AUD $2,900 – $3,400	PBS Australia
Germany	€2,000 – €2,400	G-BA Germany

Top 5 Global Brands

While Stribild is a specific antiretroviral medication, there are other major pharmaceutical companies that are known for their contributions to HIV treatment and care.

1. Gilead Sciences

• Gilead Sciences is the manufacturer of Stribild and a leader in HIV treatment with a broad portfolio of antiretroviral medications, including Truvada and Biktarvy.

2. ViiV Healthcare

• ViiV Healthcare is a global specialist in HIV treatment, known for medications such as Tivicay (dolutegravir) and Triumeq (abacavir/dolutegravir/lamivudine).

3. Merck & Co.

• Merck has been a pioneer in HIV treatment with drugs like Isentress (raltegravir) and Doravirine.

4. AbbVie

• AbbVie is known for Kaletra (lopinavir/ritonavir), a protease inhibitor combination that has been a mainstay in HIV therapy.

5. Janssen Pharmaceuticals

• Janssen, a subsidiary of Johnson & Johnson, produces several antiretroviral medications, including Prezista (darunavir) and Edurant (rilpivirine).