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AIDS and HIV Information

AIDS and HIV Information

Genvoya vs Odefsey

Genvoya vs Odefsey


Genvoya and Odefsey are both first-line treatment regimens for Human Immunodeficiency Virus type 1 released by the pharmaceutical company Gilead Sciences Inc. They also both contain emtricitabine and the novel tenofovir prodrug called tenofovir alafenamide (TAF). Their main difference, in terms of drug composition, is the addition of the booster cobicistat in Genvoya. Odefsey was given FDA approval a year after Genvoya hit the market. For years, combination antiretroviral therapy (ART) has been the mainstay of treatment for HIV-1 infection. These regimens resulted to rapid reduction of viral RNA, improved immune function, and reduced mortality.

Genvoya (elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide)

Genvoya is a fixed dose, 4-in-1 combination treatment regimen for HIV infection that can be given to patients with impaired kidney function. It contains two NRTIs (nucleoside/nucleotide reverse transcriptase inhibitor) emtricitabine and tenofovir and one INSTI (integrase strand transfer inhibitor) elvitegravir. Cobicistat is added to enhance the effects of these anti-HIV drugs. The old tenofovir (TDF) was replaced with a new prodrug TAF, which is found to be less toxic to kidneys and bones. While there are fewer side effects associated with Genvoya, TAF may cause an increase in cholesterol and triglyceride levels in the blood. The pharmacokinetic booster cobicistat may also interact with many drugs and cause additional adverse effects.

Odefsey (emtricitabine/rilpivirine/tenofovir alafenamide)

Odefsey is a complete, single-tablet, anti-HIV prescription medication used to treat adult patients and adolescents 12 years of age and older. It is a TAF-based antiretroviral regimen, which is an upgraded version of Complera. Despite the many disadvantages of Complera, you can stay with your current regimen if you are not experiencing bothersome side effects that hinder treatment adherence. If you have not received ART before, and you want to protect yourself from possible kidney impairment and bone density loss, Odefsey is worth considering.

Genvoya vs Odefsey comparison chart

 

GENVOYA
(elvitegravir, cobicistat, emtricitabine, tenofovir alafenamide)

 

ODEFSEY
(emtricitabine, rilpivirine, tenofovir alafenamide)

Approval Date

November 5, 2015

March 1, 2016

Indications

Recommended as first-line treatment regimen for HIV-infected adults and adolescents 12 years of age and older, weighing at least 35 kilograms and with a creatinine clearance of at least 30ml/min.

Recommended as first line treatment regimen for treatment-naïve patients with viral load of equal to or less than 100,000 copies/mL and CD4 T-cell count of above 200 cells/mm; suppressed patients with viral load of less than 50 copies/ml for at least 6 months.

Half-Life

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

Dosage

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

Oral tablet containing 25mg rilpivirine, 200mg emtricitabine, and 25mg tenofovir alafenamide

Advantages

  • More convenient to take as it combines four drugs in one tablet
  • Improved cellular penetration, lower drug levels in the blood
  • Contains the new and less toxic tenofovir alafenamide
  • Comes in a one pill, once-daily tablet for patient’s convenience
  • As effective as Complera but with fewer side effects
  • Contains the new tenofovir prodrug which is less toxic to kidneys and bones

Disadvantages

  • Must be taken with food
  • May interact with many drugs because of the booster component
  • May increase blood cholesterol levels
  • Should be taken with a full meal
  • Not recommended as initial treatment for patients with a viral load of more than 100,000 copies/ml and CD4 T-cell count of less than 200 cells/mm3
  • May increase blood cholesterol levels

Side Effects

  • Nausea
  • Headache
  • Fatigue
  • Diarrhea
  • Nausea
  • Insomnia
  • Headache
  • Depressive disorders

Risk Factors

  • Obesity
  • Being a woman
  • Lactic acidosis
  • Worsening of Hepatitis B infection
  • Liver problems
  • Enlarged fatty liver
  • Immune reconstitution syndrome
  • Women
  • Obesity
  • Liver problems and hepatitis B infection
  • Lactic acidosis
  • May cause kidney damage when taken that other medicines that are toxic to the kidneys

Cost

Starts at $2900+ for a 30-tablet bottle

Starts at $2600+ for a 30-tablet bottle


NRTI serves as the backbone of ART. Tenofovir, in the form of tenofovir disoproxil fumarate (TDF), is one of the most widely used NRTIs in previously recommended antiretroviral regimens. However, long-term exposure to TDF is also associated with kidney impairment and bone density loss. Now that HIV/AIDS patients are living longer from antiretroviral treatments, the release of Genvoya and Odefsey is a necessary step in addressing the long-term health effects of ART in a patient population with an improving life expectancy. Talk to your health care provider if you want to know if Genvoya or Odefsey is the best regimen for you.

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