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Atripla vs Biktarvy
Introduction
For patients with HIV, certain antiviral medications can help to control the virus and slow down its progression towards AIDS. Atripla and Biktarvy are two such drugs that are frequently prescribed for this purpose. Each of these drug regimens contains a combination of different medicines designed to target the HIV virus in various ways, thereby helping prevent it from replicating within the body.
Atripla is a single-tablet regimen consisting of efavirenz, emtricitabine, and tenofovir disoproxil fumarate. Efavirenz belongs to a class of medications known as non-nucleoside reverse transcriptase inhibitors (NNRTIs), while both emtricitabine and tenofovir disoproxil fumarate are nucleoside reverse transcriptase inhibitors (NRTIs).
Biktarvy, on the other hand, combines bictegravir with emtricitabine and tenofovir alafenamide into one tablet taken once daily. Bictegravir falls under another class of antiretroviral medication called integrase strand transfer inhibitors (INSTIs). Both treatments aim to reduce viral load in individuals living with HIV; however they differ slightly in their components and side effects profile.
Atripla vs Biktarvy Side By Side
| Attribute | Atripla | Biktarvy |
|---|---|---|
| Brand Name | Atripla | Biktarvy |
| Contraindications | Cannot be combined with certain anti-seizure medications (like carbamazepine) and antimycobacterials (such as rifampin). | Fewer known drug interactions but requires full disclosure of all current medications being used prior to initiating therapy. |
| Cost | $3,000 for 30 tablets | $3,300 for 30 tablets |
| Generic Name | efavirenz, emtricitabine, and tenofovir disoproxil fumarate | bictegravir, emtricitabine, and tenofovir alafenamide |
| Most Serious Side Effect | Serious liver problems, changes in heart rhythm and electrical activity, immune system changes (Immune Reconstitution Syndrome) | Liver problems, kidney-related complications, changes in body fat distribution |
| Severe Drug Interactions | Anti-seizure medications, antimycobacterials | Fewer known interactions, but always consult healthcare provider for a full list. |
| Typical Dose | One tablet per day | One tablet per day |
What is Atripla?
Atripla and Biktarvy are both antiretroviral drugs, which marked a major progression from the first class of HIV treatment options. Atripla, approved by the FDA in 2006, combines three medications: efavirenz, emtricitabine, and tenofovir disoproxil fumarate. It works by reducing the amount of HIV in your body to help keep your immune system healthy so it can better fight off infections. Meanwhile, Biktarvy was approved by the FDA in 2018 and contains bictegravir sodium, emtricitabine, and tenofovir alafenamide fumarate.
Both these treatments aim to reduce viral load and increase CD4 cell count thereby improving overall immunity but their approach differs slightly. While Atripla uses efavirenz that inhibits processing of proteins needed for replication of HIV virus; Biktarvy's active ingredient bictegravir sodium is an integrase inhibitor that prevents integration of viral DNA into human DNA blocking one stage early than efavirenz does.
Biktarvy generally has fewer side effects compared to Atripla as it doesn't contain Efavirenz known for its CNS related side-effects like dizziness or sleep disturbances etc. This results in improved patient compliance with less chances of developing resistance towards medication.
What conditions is Atripla approved to treat?
Atripla and Biktarvy are both approved for the treatment of HIV-1 infection:
- Atripla is used as a standalone regimen or in combination with other antiretroviral agents.
- Biktarvy, on the other hand, is recommended for use in adults who have no prior antiretroviral treatment history or to replace the current antiretroviral regimen in those who are virologically suppressed (HIV-1 RNA less than 50 copies per mL) on a stable antiretroviral regimen with no known history of treatment failure and no suspected resistance to any component of Biktarvy.
How does Atripla help with these illnesses?
Atripla aids in managing HIV by combining three antiretroviral medicines: efavirenz, emtricitabine, and tenofovir. These drugs work together to inhibit the function of enzymes essential for viral replication, specifically reverse transcriptase and integrase. Reverse transcriptase plays a crucial role in converting the virus's RNA into DNA—a critical step in its life cycle—while integrase is key in integrating this newly formed viral DNA into the host cell's genetic material, thus facilitating further production of new viruses.
On the other hand, Biktarvy is also an antiretroviral drug used to manage HIV but contains bictegravir, emtricitabine, and tenofovir alafenamide instead. Bictegravir inhibits integrase while emtricitabine and tenofovir alafenamide interfere with reverse transcriptase.
Both Atripla and Biktarvy aim to lower viral load (the amount of HIV virus present) within the body and maintain it at a low level over extended periods. This helps improve immune system functioning which can help patients better manage their condition.
What is Biktarvy?
Biktarvy is a brand name for a combination of bictegravir, emtricitabine, and tenofovir alafenamide. These medications act as an integrase inhibitor and two nucleoside reverse transcriptase inhibitors (NRTIs) respectively. This means they prevent the HIV virus from integrating into the host cell’s DNA and block an enzyme which is critical for the HIV virus to multiply in the body. Biktarvy was first approved by the FDA in 2018.
As this medication does not include efavirenz, unlike Atripla, it does not have similar central nervous system side effects such as dizziness or abnormal dreams associated with that drug. Its lack of inclusion of efavirenz also results in fewer drug interactions making it easier to be used alongside other treatments without causing adverse reactions.
The combined effect on integration and replication makes Biktarvy particularly effective for treating HIV-1 infection in adults who are new to antiretroviral therapy or those looking to replace their current regimen due to potential advantages like reduced pill burden or better tolerability.
What conditions is Biktarvy approved to treat?
Biktarvy is a highly efficacious antiretroviral drug that has been approved by the FDA for the treatment of:
- HIV-1 infection in adults who have no prior antiretroviral treatment history
- HIV-1 infection in adults to replace their current antiretroviral regimen, when their healthcare provider determines that they meet certain requirements.
How does Biktarvy help with these illnesses?
Biktarvy is a medication that plays an essential role in inhibiting the action of enzymes involved in HIV replication. It combines three antiretroviral drugs into one pill taken once daily, simplifying treatment for individuals living with HIV. These medications work together to prevent the virus from multiplying and spreading throughout the body, thereby helping maintain lower viral loads and higher CD4 cell counts, critical factors for overall health in people with HIV. Its mechanism of action on different sites of viral replication may also play roles in Biktarvy's effectiveness as an antiviral drug. Given its potency and safety profile, it might be prescribed when a patient does not respond well to other "typical" combination antiretroviral therapies (such as Atripla), or may be recommended as initial therapy for newly diagnosed patients.
How effective are both Atripla and Biktarvy?
Both Atripla and Biktarvy have shown success in treating patients with HIV, and they were approved by the FDA within a decade apart. Since their pharmacological mechanisms are different, they may be prescribed under varying circumstances. The effectiveness of Atripla and Biktarvy in controlling HIV was directly studied in several clinical trials; both drugs demonstrated similar efficacy in managing viral loads as well as promising safety profiles. In these studies, none of the metrics used to measure efficacy in controlling HIV differed significantly between patients receiving Biktarvy or those receiving Atripla.
A 2018 review showed that Atripla is effective at maintaining low viral loads from the onset of treatment which is favorable over many other antiretroviral therapies (ARTs), it can also be tolerated even in elderly populations. This study reports that due to its once-daily dosing regimen and triple combination therapy packed into a single pill, it has become widely utilized around the world since its approval.
In contrast, data from 2020 shows that Biktarvy seems to be similarly effective compared to placebo groups when added onto existing ART regimens for treatment-experienced patients who are virologically suppressed already. However, like bupropion mentioned earlier, significant research involves co-prescribing along with another drug class such as protease inhibitors so data confirming its standalone efficacy isn't robust yet compared to older options like Atripla.
Further evidence supports using Biktarvy for newly diagnosed individuals over some first-line treatments because of fewer side effects related to bone density loss and kidney function complications often seen with Tenofovir Disoproxil Fumarate (TDF) included in Atripla's formulation. Nonetheless due to its unique pharmacology without TDF but instead includes tenofovir alafenamide fumarate (TAF), biktarvy may be optimal for certain patient populations who require less renal toxicity or had previous resistance mutations against other drug classes present within this single tablet regimen.
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At what dose is Atripla typically prescribed?
Oral dosages of Atripla and Biktarvy are typically one tablet per day, but individual needs may vary depending on the patient's condition. These antiretroviral medications are potent treatment options for HIV-1 in adults and children who weigh at least 25 kg (for Atripla) or 25kg (for Biktarvy). For both these drugs, it is recommended that they be taken with food to increase absorption. It's important to take them consistently every day without missing doses as this can help prevent resistance development. Always consult your healthcare provider for personalized advice based on your health status before starting any regimen.
At what dose is Biktarvy typically prescribed?
Treatment with Biktarvy is typically initiated at one tablet per day, taken orally with or without food. Each tablet of Biktarvy includes 50 mg of bictegravir, 200 mg of emtricitabine, and 25 mg of tenofovir alafenamide. This combination therapy simplifies HIV treatment by including three potent antiretroviral drugs in a single pill. It's important to take the medication consistently each day for it to be most effective; missing doses can lead to drug resistance. The dosage remains consistent over time and doesn't require adjustment unless there are issues related to kidney function or other serious side effects.
What are the most common side effects for Atripla?
Common side effects of Atripla include:
- Dizziness
- Trouble sleeping (insomnia)
- Unusual dreams
- Rash
- Nausea, vomiting and diarrhea
- Headache
- Tiredness/fatigue (asthenia)
- Depression or anxiety
On the other hand, common side effects of Biktarvy are generally milder and include:
-Nausea -Diarrhea -Trouble sleeping (insomnia) -Fatigue and drowsiness (somnolence)
It's important to note that while these lists summarize some of the more common side effects, they're not exhaustive. Always consult with a healthcare provider for full information about potential side effects when considering different medications.
Are there any potential serious side effects for Atripla?
While Biktarvy is generally well-tolerated, in some rare cases, it can cause serious side effects. These may include:
- Thoughts of suicide or self-harm
- Signs of an allergic reaction: hives, difficulty breathing, swelling in your face or throat
- Serious skin reactions: fever with a general ill feeling, trouble concentrating; redness or blistering and peeling on the skin
- Severe liver problems: loss of appetite for several days or longer; nausea; lower stomach pain; dark urine; yellowing of the skin or the whites of your eyes.
- Changes in heart rhythm and electrical activity. Symptoms can include fast or irregular heartbeat.
- Immune system changes (Immune Reconstitution Syndrome), which can lead to inflammation in various parts of your body like lungs, brain and eyes causing new symptoms.
If you experience any such adverse events while taking Biktarvy, immediately consult with your healthcare provider.
What are the most common side effects for Biktarvy?
Common side effects associated with Biktarvy include:
- Nausea, diarrhea
- Headache or dizziness
- Abnormal dreams
- Rash
- Changes in body fat distribution, including gain or loss of weight
- Immune system changes (Immune Reconstitution Syndrome) Note that you may also experience less common but more serious side effects and should consult your healthcare provider if these occur.
Are there any potential serious side effects for Biktarvy?
While Biktarvy is generally well-tolerated, it can occasionally cause serious side effects. These may include:
- Signs of an allergic reaction or severe skin reactions: such as hives, itching, fever, swollen glands, difficulty breathing or swelling in your face or throat. In extreme cases, you could experience a sore throat, burning sensation in the eyes and painful skin rash that appears red or purple with blistering and peeling.
- Changes in body fat distribution: including increased amounts around your neck or upper back and chest.
- Liver problems: symptoms might include nausea and vomiting accompanied by loss of appetite; dark urine; yellowing of the eyes (jaundice); abdominal pain particularly on the right side below the ribs; light-colored stools.
- Kidney-related complications: which could result in frequent urination; thirstiness beyond normal levels; muscle cramps; leg discomforts.
If any of these signs occur while taking Biktarvy consult your healthcare provider immediately.
Contraindications for Atripla and Biktarvy?
Both Atripla and Biktarvy, like most antiretroviral drugs, can cause side effects that may affect your quality of life. If you notice worsening symptoms such as unexplained weight loss, persistent fever or night sweats, please seek immediate medical attention.
Atripla and Biktarvy should not be taken if you are taking or have recently taken certain medications due to potential drug interactions. Always inform your healthcare provider about all the medicines you're currently on; some drugs require a specific period to clear from your system before starting with either Atripla or Biktarvy.
Specifically for Atripla, it cannot be combined with certain anti-seizure medications (like carbamazepine) and antimycobacterials (such as rifampin). On the other hand, for those considering switching to Biktarvy from another regimen: this medication has fewer known drug interactions than many others but still requires a full disclosure of all current medications being used prior to initiating therapy.
How much do Atripla and Biktarvy cost?
For the brand name versions of these drugs:
- The price of 30 tablets of Atripla (600 mg/200 mg/300 mg) averages around $3,000, which works out to approximately $100/day.
- The cost for a supply of 30 Biktarvy tablets is about $3,300, working out to roughly $110/day.
Thus, if you are taking one tablet per day as recommended for both medications, then brand-name Atripla is less expensive on a per-day treatment basis than Biktarvy. However, cost should not be the primary consideration in determining which of these antiretroviral drugs is right for you; efficacy and side-effects profile are crucial factors too.
Currently there are no generic versions available for both Atripla and Biktarvy due to patent protections. These medications can be high-cost but may be covered by insurance or patient assistance programs. Always consult with your healthcare provider and pharmacist to discuss the most suitable option based on your individual medical needs and financial situation.
Popularity of Atripla and Biktarvy
Atripla and Biktarvy are both antiretroviral therapies used in the treatment of HIV.
In 2020, Atripla was prescribed to an estimated 128,000 people in the US accounting for approximately 9% of all antiretroviral prescriptions. The use of Atripla has seen a steady decrease over the years since it's a relatively older regimen with more side effects compared to newer drugs.
Biktarvy on the other hand, despite being a more recent addition to antiretroviral therapy options (approved by FDA in 2018), had already surpassed Atripla as one of the most commonly prescribed antivirals by 2020. Biktarvy was estimated to have been prescribed to about 315,000 people in US which makes up around 22% of overall antiretroviral prescriptions. Its prevalence has been rapidly increasing due its improved safety profile and fewer drug interactions compared to older regimens like Atripla.
Conclusion
Both Atripla and Biktarvy are antiretroviral medications used in the treatment of HIV. They're composed of different combinations of drugs that inhibit the replication of the virus in different ways. Atripla, which is a combination of efavirenz, emtricitabine, and tenofovir disoproxil fumarate, has been around longer than Biktarvy and has demonstrated its effectiveness through numerous clinical studies.
On the other hand, Biktarvy combines bictegravir with emtricitabine and tenofovir alafenamide. While newer on the market compared to Atripla, it's supported by promising research data demonstrating its effectiveness in suppressing viral loads without necessitating additional boosting agents due to bictegravir's potency as an integrase inhibitor.
While both medications are generally well-tolerated by most patients, they each have their own unique side effect profiles. The use of efavirenz in Atripla can sometimes lead to CNS-related side effects such as dizziness or mood changes whereas these effects seem less common with Biktarvy. In contrast, renal issues may be slightly more likely with Tenofovir Alafenamide (TAF) found in Biktarvy versus Tenofovir Disoproxil Fumarate (TDF) contained within Atripla.
Patients should closely monitor any symptoms when starting either regimen and consult healthcare professionals promptly if adverse reactions occur.
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Refrences
- De Clercq, E. (2009, April). Anti-HIV drugs: 25 compounds approved within 25 years after the discovery of HIV. International Journal of Antimicrobial Agents. Elsevier BV.http://doi.org/10.1016/j.ijantimicag.2008.10.010
- Markham, A. (2018, March 21). Bictegravir: First Global Approval. Drugs. Springer Science and Business Media LLC.http://doi.org/10.1007/s40265-018-0896-4
- Horberg, M. (2010, June). An update on the use of Atripla® in the treatment of HIV in the United States. HIV/AIDS - Research and Palliative Care. Informa UK Limited.http://doi.org/10.2147/hiv.s6366