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AIDS and HIV Information

AIDS and HIV Information

Triumeq vs Genvoya

Triumeq vs Genvoya


One of the key milestones in the field of HIV medications is the introduction of single-tablet regimen (STR) in 1996. Standard antiretroviral therapy (ART) has evolved since then. The Department of Health and Human Services recommend the combination of three or more medications from at least 2 different drug classes for a complete HIV-1 antiretroviral regimen. Triumeq and Genvoya are two STRs approved as initial antiretroviral treatment for most people. Both are highly potent against HIV but each may have their own associated risks and disadvantages. 

Triumeq (dolutegravir/abacavir/lamivudine)

Triumeq is developed and manufactured by ViiV Healthcare, an HIV company established by GlaxoSmithKline and Pfizer. This regimen is the only single-tablet medication with an abacavir/lamivudine (Epzicom) nucleoside backbone. It is only recommended for patients who test negative to the HLA-B*5701 gene. Unlike Genvoya’s elvitegravir, Triumeq contains the integrase inhibitor dolutegravir, which does not require a booster. This means Triumeq has fewer side effects and possible drug interactions than Genvoya. But, its active ingredient abacavir may cause hypersensitivity reactions, hence the initial HLA-B*5701 testing requirement. Additionally, there are studies linking abacavir with increased heart attack risk, so people with heart disease or several risk factors for heart disease must avoid abacavir-containing meds.

Genvoya (elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide)

This regimen is the improved version of Stribild (elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate). The old prodrug tenofovir disoproxil fumarate (TDF) in many STRs is replaced by tenofovir alafenamide (TAF) in Genvoya. The downside of Genvoya is the booster cobicistat that may interact with a long list of medications, such as statins, birth control pills, nasal corticosteroids, and erectile dysfunction drugs, just to name a few. The amount of tenofovir is also reduced in this drug, from 300mg to 10mg. In theory, it could mean less amount of the drug stays in the bloodstream to cause potential adverse events (e.g., kidney and bone toxicity).

Triumeq vs Genvoya: side by side comparison

 

GENVOYA
(elvitegravir, cobicistat, emtricitabine, tenofovir alafenamide)

 

TRIUMEQ
(dolutegravir/abacavir/lamivudine)

Manufacturer

Gilead Sciences

ViiV Healthcare

Approval Date

November 5, 2015

August 22, 2014

Indications

Included in the HHS guidelines as first-line treatment regimen for HIV-infected adults and adolescents 12 years of age and older, weighing at least 35 kilograms (77 pounds)

Included in the HHS guidelines as first-line treatment regimen for HIV-infected adults and children 12 years of age and older, weighing at least 40 kilograms (88 pounds)

Biological Half-Life

  • Elvitegravir – 12.9 hours
  • Cobicistat – 3.5 hours
  • Emtricitabine – 10 hours
  • Tenofovir alafenamide – 1 hour
  • Dolutegravir – 14 hours
  • Abacavir – 1.5 hours
  • Lamivudine – 15–16 hours

Dosage

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

Oral tablet containing 600mg dolutegravir, 50mg abacavir, and 300mg lamivudine

Advantages

  • Easier to take as it combines four HIV drugs in one tablet
  • Contains tenofovir alafenamide instead of TDF, which is less toxic to kidneys and bones
  • Improved cellular penetration for tenofovir could mean lower drug levels in the blood
  • Can be taken with or without food
  • More convenient than other regimens as it contains three drugs in one tablet
  • No booster requirement, thus fewer drug interactions
  • Contains dolutegravir, eliminating TDF-associated kidney toxicity and decreased bone mineral density

Disadvantages

  • Must be taken with food
  • May interact with many drugs because of the booster component (cobicistat)
  • May increase blood cholesterol and triglyceride levels
  • May increase your risk of heart attack, especially if you have several risk factors for heart disease
  • Not recommended for people with severe liver and kidney impairment
  • Pre-screening for HLA-B*5701 gene mutation is required for abacavir-associated allergic reactions

Side Effects

  • Nausea
  • Headache
  • Fatigue
  • Diarrhea
  • Nausea
  • Insomnia
  • Headache
  • Fatigue

Risk Factors

  • Obesity
  • Being a woman
  • Lactic acidosis
  • Worsening of Hepatitis B infection
  • Liver problems
  • Enlarged fatty liver
  • Immune reconstitution syndrome
  • Many drug interactions
  • Obesity
  • Being a woman
  • Worsening of Hepatitis B or C infection
  • Liver problems
  • Lactic acidosis with severe hepatomegaly and steatosis
  • Hypersensitivity reactions
  • Fat redistribution
  • Immune reconstitution syndrome
  • Heart attack
  • Dyslipidemia

Cost

Starts at $2900+ for a 30-tablet bottle

Starts at $2700+ for a 30-tablet bottle


Despite the big leaps that pharmaceutical companies and healthcare providers have accomplished to improve the life expectancy of HIV-infected patients, there is still no cure for the dreaded disease. Still, pharmacological therapies have come a long way; Triumeq and Genvoya, for example, have high success rate of up to 90%. If you’re still using the old, previously recommended regimens like Stribild and Atripla, it might be time to discuss with your healthcare team if a switch to newer, less toxic regimens would be beneficial. Even patients who are having well tolerated side effects from their current regimen may feel better using the latest antiretroviral meds.

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