Effectiveness of the combination elvitegravir/cobicistat/tenofovir/emtricitabine (EVG/COB/TFV/FTC) plus darunavir among treatment-experienced patients in clinical practice: a multicentre cohort study
Authors: Suárez-García Inés , Moreno Cristina , Ruiz-Algueró Marta , Pérez-Elías María Jesús , Navarro Marta , Díez Martínez Marcos , Viciana Pompeyo , Pérez-Martínez Laura , Górgolas Miguel , Amador Concha , de Zárraga Miguel Alberto , Jarrín Inma ,   the Cohort of the Spanish HIV/AIDS Research Network (CoRIS), Moreno Santiago , Jarrín Inma , Dalmau David , Navarro Maria Luisa , González Maria Isabel , Garcia Federico , Poveda Eva , Iribarren Jose Antonio , Gutiérrez Félix , Rubio Rafael , Vidal Francesc , Berenguer Juan , González Juan , Muñoz-Fernández M Ángeles , Jarrin Inmaculada , Alejos Belén , Moreno Cristina , Iniesta Carlos , Sousa Luis Miguel Garcia , Perez Nieves Sanz , Rava Marta , Muñoz-Fernández M Ángeles , Fernández Irene Consuegra , Merino Esperanza , García Gema , Portilla Irene , Agea Iván , Portilla Joaquín , Sánchez-Payá José , Rodríguez Juan Carlos , Gimeno Lina , Giner Livia , Díez Marcos , Carreres Melissa , Reus Sergio , Boix Vicente , Torrús Diego , Lirola Ana López , García Dácil , Díaz-Flores Felicitas , Gómez Juan Luis , del Mar Alonso María , Pelazas Ricardo , Hernández Jehovana , Alemán María Remedios , Hernández María Inmaculada , Asensi Víctor , Valle Eulalia , Carmenado María Eugenia Rivas , Secades Tomas Suarez-Zarracina , Is Laura Pérez , Rubio Rafael , Pulido Federico , Bisbal Otilia , Hernando Asunción , Domínguez Lourdes , Crestelo David Rial , Bermejo Laura , Santacreu Mireia , Iribarren José Antonio , Arrizabalaga Julio , Aramburu María José , Camino Xabier , Rodríguez-Arrondo Francisco , von Wichmann Miguel Ángel , Tomé Lidia Pascual , Goenaga Miguel Ángel , Bustinduy Mª Jesús , Azkune Harkaitz , Ibarguren Maialen , Lizardi Aitziber , Kortajarena Xabier , Oyaga Mª Pilar Carmona , Igartua Maitane Umerez , Gutiérrez Félix , Masiá Mar , Padilla Sergio , Navarro Andrés , Montolio Fernando , Robledano Catalina , Colomé Joan Gregori , Adsuar Araceli , Pascual Rafael , Fernández Marta , García Elena , García José Alberto , Barber Xavier , Muga Roberto , Sanvisens Arantza , Fuster Daniel , Berenguer Juan , de Quirós Juan Carlos López Bernaldo , Gutiérrez Isabel , Ramírez Margarita , Padilla Belén , Gijón Paloma , Aldamiz-Echevarría Teresa , Tejerina Francisco , Parras Francisco José , Balsalobre Pascual , Diez Cristina , Latorre Leire Pérez , Fanciulli Chiara , Vidal Francesc , Peraire Joaquín , Viladés Consuelo , Veloso Sergio , Vargas Montserrat , Olona Montserrat , Rull Anna , Rodríguez-Gallego Esther , Alba Verónica , Castellanos Alfonso Javier , López-Dupla Miguel , Alonso Marta Montero , Aldeguer José López , Juliá Marino Blanes , Pitarch María Tasias , Hernández Iván Castro , Muñoz Eva Calabuig , Tovar Sandra Cuéllar , Lletí Miguel Salavert , Navarro Juan Fernández , González-Garcia Juan , Arnalich Francisco , Arribas José Ramón , de la Serna Jose Ignacio Bernardino , Castro Juan Miguel , Escosa Luis , Herranz Pedro , Hontañón Victor , García-Bujalance Silvia , López-Hortelano Milagros García , González-Baeza Alicia , Martín-Carbonero Maria Luz , Mayoral Mario , Mellado Maria Jose , Micán Rafael Esteban , Montejano Rocio , Montes María Luisa , Moreno Victoria , Pérez-Valero Ignacio , Rodés Berta , Sainz Talia , Sendagorta Elena , Alcáriz Natalia Stella , Valencia Eulalia , Blanco José Ramón , Oteo José Antonio , Ibarra Valvanera , Metola Luis , Sanz Mercedes , Pérez-Martínez Laura , Arazo Piedad , Sampériz Gloria , Dalmau David , Jaén Angels , Sanmartí Montse , Cairó Mireia , Martinez-Lacasa Javier , Velli Pablo , Font Roser , Xercavins Mariona , Alonso Noemí , Marcotegui Maria Rivero , Repáraz Jesús , de Alda María Gracia Ruiz , de León Cano María Teresa , de Galarreta Beatriz Pierola Ruiz , Amengual María José , Navarro Gemma , Garcia Manel Cervantes , Isbert Sonia Calzado , Vilasaro Marta Navarro , de los Santos Ignacio , Sanz Jesus Sanz , Aparicio Ana Salas , Cepeda Cristina Sarria , Fraile Lucio Garcia-Fraile , Gayo Enrique Martín , Moreno Santiago , Osorio José Luis Casado , Nuñez Fernando Dronda , Zamora Ana Moreno , Elías Maria Jesús Pérez , Gutiérrez Carolina , Madrid Nadia , del Campo Terrón Santos , Villar Sergio Serrano , Gallego Maria Jesús Vivancos , Sanz Javier Martínez , Urroz Usua Anxa , Velasco Tamara , Bernal Enrique , Sanchez Alfredo Cano , García Antonia Alcaraz , Urbieta Joaquín Bravo , Perez Angeles Muñoz , Alcaraz Maria Jose , del Carmen Villalba Maria , García Federico , Quero José Hernández , Medina Leopoldo Muñoz , Alvarez Marta , Chueca Natalia , García David Vinuesa , Martinez-Montes Clara , Beltran Carlos Guerrero , de Salazar Gonzalerz Adolfo , Lopez Ana Fuentes , Utrilla Montserrat Raposo , Del Romero Jorge , Rodríguez Carmen , Puerta Teresa , Carrió Juan Carlos , Vera Mar , Ballesteros Juan , Ayerdi Oskar , Antela Antonio , Losada Elena , Riera Melchor , Peñaranda María , Leyes María , Ribas Mª Angels , Campins Antoni A , Vidal Carmen , Fanjul Francisco , Murillas Javier , Homar Francisco , Santos Jesús , Ayerbe Crisitina Gómez , Viciana Isabel , Palacios Rosario , López Carmen Pérez , Gonzalez-Domenec Carmen Maria , Viciana Pompeyo , Espinosa Nuria , López-Cortés Luis Fernando , Podzamczer Daniel , Imaz Arkaitz , Tiraboschi Juan , Silva Ana , Saumoy María , Prieto Paula , Ribera Esteban , Curran Adrian , Sierra Julián Olalla , Stachowski Javier Pérez , del Arco Alfonso , de la torre Javier , Prada José Luis , de Lomas Guerrero José María García , Martínez Onofre Juan , Vera Francisco Jesús , Martínez Lorena , García Josefina , Alcaraz Begoña , Jimeno Amaya , Iglesias Angeles Castro , Souto Berta Pernas , de Cea Alvaro Mena , Muñoz Josefa , Zubero Miren Zuriñe , Baraia-Etxaburu Josu Mirena , Ugarte Sofía Ibarra , Beneitez Oscar Luis Ferrero , de Munain Josefina López , López Mª Mar Cámara , de la Peña Mireia , Lopez Miriam , Azkarreta Iñigo Lopez , Galera Carlos , Albendin Helena , Pérez Aurora , Iborra Asunción , Moreno Antonio , Merlos Maria Angustias , Vidal Asunción , Meca Marisa , Amador Concha , Pasquau Francisco , Ena Javier , Benito Concha , Fenoll Vicenta , Anguita Concepcion Gil , Rabasa Jose Tomas Algado , Suárez-García Inés , Malmierca Eduardo , González-Ruano Patricia , Rodrigo Dolores Martín , Seco Mª Pilar Ruiz , Mohamed-Balghata Mohamed Omar , Vidal María Amparo Gómez , de Zarraga Miguel Alberto , Pérez Vicente Estrada , Molina Maria Jesus Téllez , García Jorge Vergas , Moreno Juncal Pérez-Somarriba , Górgolas Miguel , Cabello Alfonso , Álvarez Beatriz , Prieto Laura , Moreno José Sanz , Caso Alberto Arranz , Gutiérrez Cristina Hernández , Mena María Novella , Puerto María José Galindo , Vilalta Ramón Fernando , Ribera Ana Ferrer , Román Antonio Rivero , Juárez Antonio Rivero , López Pedro López , Sánchez Isabel Machuca , Casas Mario Frias , Espejo Angela Camacho , Jiménez Miguel Cervero , Perea Rafael Torres , Pineda Juan A , Mayo Pilar Rincón , Sanchez Juan Macias , Gutierrez Nicolas Merchante , Real Luis Miguel , Gomez Anais Corma , Fuertes Marta Fernandez , Gonzalez-Serna Alejandro , Poveda Eva , Pérez Alexandre , Crespo Manuel , Morano Luis , Miralles Celia , Ocampo Antonio , Pousada Guillermo 
Published: July 2020

Abstract
Background
The aim of this study was to investigate the effectiveness and tolerability of the combination elvitegravir/cobicistat/tenofovir/emtricitabine plus darunavir (EVG/COB/TFV/FTC + DRV) in treatment-experienced patients from the cohort of the Spanish HIV/AIDS Research Network (CoRIS).

Methods
Treatment-experienced patients starting treatment with EVG/COB/TFV/FTC + DRV during the years 2014–2018 and with more than 24 weeks of follow-up were included. TFV could be administered either as tenofovir disoproxil fumarate or tenofovir alafenamide. We evaluated virological response, defined as viral load (VL) < 50 copies/ml and < 200 copies/ml at 24 and 48 weeks after starting this regimen, stratified by baseline VL (< 50 or ≥ 50 copies/ml at the start of the regimen).

Results
We included 39 patients (12.8% women). At baseline, 10 (25.6%) patients had VL < 50 copies/ml and 29 (74.4%) had ≥ 50 copies/ml. Among patients with baseline VL < 50 copies/ml, 85.7% and 80.0% had VL < 50 copies/ml at 24 and 48 weeks, respectively, and 100% had VL < 200 copies/ml at 24 and 48 weeks. Among patients with baseline VL ≥ 50 copies/ml, 42.3% and 40.9% had VL < 50 copies/ml and 69.2% and 68.2% had VL < 200 copies/ml at 24 and 48 weeks. During the first 48 weeks, no patients changed their treatment due to toxicity, and 4 patients (all with baseline VL ≥ 50 copies/ml) changed due to virological failure.

Conclusions
EVG/COB/TFV/FTC + DRV was well tolerated and effective in treatment-experienced patients with undetectable viral load as a simplification strategy, allowing once-daily, two-pill regimen with three antiretroviral drug classes. Effectiveness was low in patients with detectable viral loads.