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AIDS and HIV Information

AIDS and HIV Information

Genvoya vs Truvada: What is the Real Difference?

Genvoya vs Truvada


For over a decade, HIV specialists have combined three or more antiretroviral agents in one potent regimen that could successfully impair viral replication, resulting in a slower progression of the disease into full-blown AIDS. However, single-tablet regimens (STR), which is a combination of three or more antiretroviral drugs in one fixed-dose pill, was only made possible in the past few years. The availability of these co-formulated medicines has been a favorable discovery for HIV-infected individuals as it reduces the number of pills to be taken daily.

What experts say?

Genvoya and Truvada are two combination treatments recommended by The Department of Health and Human Services (DHHS) HIV guidelines. While they are partially similar in drug components, they are not interchangeable. Switching between the two regimens must be supervised by your healthcare team. Doctors who specialize in HIV/AIDS cases can better assess your condition and explain how a switch can affect viral suppression, new onset or worsening of adverse effects, and long-term outcomes.

Some patients may prefer Truvada to Genvoya because the former is cheaper and more accessible. In developing countries or low-income nations, recently approved drugs may be either unavailable or too expensive. Since both drugs have been studied extensively for safety and efficacy, ultimately getting the coveted positions in official HIV guidelines list of “recommended regimens for most people,” it seems like there is no bad choice between Genvoya and Truvada. However, these drugs are not for everyone.

Is it okay to switch from Genvoya to Truvada?

First and foremost, Truvada is not a complete HIV regimen. According to the updated guidelines, a complete STR must contain a combination of three or more antiretroviral drugs from at least two different classes. Truvada contains emtricitabine and tenofovir disoproxil fumarate—two potent nucleoside/nucleotide reverse transcriptase inhibitors (NRTI)—but it needs a third antiretroviral agent from another drug class. An integrase strand transfer inhibitor (INSTI), such as dolutegravir (Tivicay) or raltegravir (Isentress), is recommended by the DHHS guidelines to form a complete regimen with Truvada. Dolutegravir (DTG) is also part of Triumeq, another preferred STR with a good safety profile. DTG is a promising drug, which is one of the most recently approved and most effective drugs to reduce viral load. It also has fewer side effects. Most INSTIs require a booster except DTG, which means there are less negative drug-drug interactions associated with this medication.

Instead of DTG, Genvoya contains elvitegravir (Vitekta), an integrase inhibitor that requires a pharmacological enhancer or booster. In Genvoya, the booster used is cobicistat. One advantage of Genvoya over Truvada is the replacement of the old tenofovir (TDF) with the new prodrug tenofovir alafenamide (TAF). The original tenofovir is associated with bone and kidney toxicities. It has been found that such risks are lower in TAF. However, the risk for high cholesterol levels is greater in Genvoya. Some doctors may not suggest a switch to Genvoya from a TDF-containing regimen if the patient has healthy bones and kidneys with well-tolerated adverse effects. Aside from treating an existing HIV infection (with additional antiretroviral agents), Truvada is also recommended as preventative or pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) treatment for high-risk individuals (e.g., men who have sex with men). The bottom line is, if you need a regimen for preventative measures, you doctor may prescribe Truvada, so you can’t switch to Genvoya as it is not meant for PrEP nor PEP treatment. If you are HIV-positive, you can possibly take any of the two, provided an additional integrase inhibitor is added to your Truvada prescription.

Genvoya vs Truvada: head-to-head comparison

 

Genvoya

(elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide)

 

Truvada

(emtricitabine/tenofovir disoproxil fumarate)

 

Manufacturer

Gilead Sciences

Gilead Sciences

Food Interaction

Must be taken after a meal

Can be taken with or without food

Approval Date

November 5, 2015

August 2, 2004

Indications

Recommended treatment regimen for HIV-infected adults and adolescents 12 years of age and older, weighing at least 35 kilograms (77 pounds)

  • Recommended treatment regimen for HIV-infected individuals from the age of 12 and above with additional dolutegravir or raltegravir
  • Indicated as PrEP and PEP for high-risk individuals

Biological Half-Life

  • Elvitegravir – 12.9 hours
  • Cobicistat – 3.5 hours
  • Emtricitabine – 10 hours
  • Tenofovir alafenamide – 1 hour
  • Emtricitabine – 10 hours
  • Tenofovir disoproxil fumarate – 17 hours

Formulations

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

Oral tablet containing 200mg emtricitabine, and 300mg tenofovir

Advantages

  • Comes in a convenient 4-in-1 tablet
  • Contains the new tenofovir (TAF), which is less toxic to kidneys and bones
  • Lower drug exposure due to improved cellular penetration from TAF
  • Can be used as pre- or post-exposure prophylaxis
  • Not associated with major, lasting kidney problems despite the TDF component
  • Relatively more affordable than other combination regimens

Disadvantages

  • Should not be taken on an empty stomach
  • May increase blood cholesterol and triglyceride levels
  • Associated with many drug-drug interactions because of cobicistat
  • May cause bone impairment
  • Not recommended for those with severe kidney problems
  • May worsen existing hepatitis B infection upon stopping treatment
  • Must be combined with other antiretroviral medications

Side Effects

  • Nausea
  • Headache
  • Fatigue
  • Diarrhea
  • Diarrhea
  • Nausea
  • Headache
  • Dizziness

 

Cost

Around $102.78 per tablet without insurance

Around $31.57 per tablet without insurance

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