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AIDS and HIV Information

AIDS and HIV Information

Genvoya vs Complera

Genvoya vs Complera


The history of single-tablet regimens (STR) started with Atripla—the first and only approved STR for HIV-1 infection—until the introduction of Complera in 2011. Stribild was then released the following year. The makers of Atripla, Gilead Sciences, just recently gained approval to market Genvoya and mark another milestone in HIV treatment and prevention. Genvoya is included in the preferred treatment list of US Department of Health and Human Services (DHHS) for treatment-naïve adults and adolescents, while Complera is suggested as an alternative treatment for HIV-positive individuals with viral loads below 100,000 copies and CD4 count of above 200.

Complera (rilpivirine/tenofovir disoproxil fumarate/emtricitabine)

Complera has fallen from the recommended list to the alternative list because of lower effectiveness for those with higher viral loads and low CD4 T-cell counts and the need to take Complera with a full meal. Taking Complera also requires avoiding antacids and other commonly used drugs. Although an antiretroviral drug is no longer part of the “recommended” list, it doesn’t mean you should immediately switch to a new regimen. Old antiretroviral therapies may be fine for those who are already taking it with well-tolerated side effects. Odefsey, an updated version of Complera, contains tenofovir alafenamide, a better and safer tenofovir pro-drug. So if you are not satisfied with Complera or if you are experiencing bothersome side effects, you should consider switching to the new TAF-containing regimen.

Genvoya (elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide)

Genvoya contains three different types of antiretroviral drugs. In terms of effectiveness and safety, it is similar to Stribild except that the original tenofovir is replaced by tenofovir alafenamide (TAF). While it is still associated with kidney and bone toxicities, the risk is lower compared to regimens containing the old tenofovir. TAF is said to be better absorbed while offering less systemic exposure. One disadvantage of Genvoya is the addition of booster cobicistat. The pharmacokinetic enhancer or booster does not affect HIV infected cells, but it enhances the effectiveness of the three drugs in Genvoya.

Genvoya vs Complera: Side by side comparison

 

GENVOYA
(elvitegravir, cobicistat, emtricitabine, tenofovir alafenamide)

 

COMPLERA
(rilpivirine, tenofovir disoproxil fumarate, emtricitabine)

Approval Date

November 5, 2015

August 10, 2011

Indications

HIV-infected adults and adolescents 12 years of age and older, weighing at least 35 kilograms

  • HIV-infected adults and adolescents 12 years of age and older with viral load of equal to or less than 100,000 copies/mL and CD4 count above 200 cells/mm3

 

HHS Guidelines

Included as a recommended regimen

Included as an alternative regimen

Half-Life

  • Elvitegravir – 12.9 hours
  • Cobicistat – 3.5 hours
  • Emtricitabine – 10 hours
  • Tenofovir alafenamide – 1 hour
  • Emtricitabine – 10 hours
  • Rilpivirine – 50 hours
  • Tenofovir – 17 hours

Dosage

Oral tablet containing 150mg elvitegravir, 150mg cobicistat, 10mg tenofovir alafenamide fumarate, and 200mg emtricitabine

Oral tablet containing 25mg rilpivirine, 300mg tenofovir disoproxil fumarate, and 200mg emtricitabine

Advantages

  • Included in the recommended list of HIV treatment regimens
  • Easy to take as it contains four drugs in one tablet
  • Better cellular penetration, lower levels in the blood
  • Contains the newer and less toxic tenofovir pro-drug
  • Included in the alternative list of HIV treatment regimens
  • Easy to take as it contains three medications in one pill
  • Drug assistance program and co-pays are available

Disadvantages

  • Must be taken with food
  • May interact with many drugs because of cobicistat
  • May increase blood cholesterol levels
  • Must be taken with a light fatty meal
  • Interacts with acid reducers (proton pump inhibitors)
  • Not recommended for patients with high viral load or low immune cells
  • Not for patients with severe kidney damage
  • Associated with bone toxicity

Side Effects

  • Nausea
  • Headache
  • Fatigue
  • Diarrhea
  • Nausea
  • Headache
  • Insomnia
  • Rash
  • Depressive symptoms

Risk Factors

  • Obesity
  • Worsening of Hepatitis B infection
  • Liver problems
  • Lactic acidosis
  • Enlarged fatty liver
  • Immune reconstitution syndrome

 

  • Obesity
  • Liver disease
  • Hypersensitivity reactions
  • Lactic acidosis
  • Enlarged fatty liver
  • Mood and behavioral changes or mental health problems
  • History of kidney impairment
  • Bone loss or osteoporosis
  • May have a negative interaction with alcohol

 

Cost

Starts at $2,900+ for a 30-tablet bottle

Starts at $2,600+ for a 30-tablet bottle

The bottom line

It is worth discussing with your doctor if a switch to a new regimen will benefit your condition. Keep in mind that your doctor will determine the best treatment for your condition. Continue to update your doctor regarding any side effects you are experiencing and keep track of how you feel over the course of your treatment.

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