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Atripla vs Genvoya
Introduction
For patients with HIV infection, certain drugs that interfere with the life cycle of the virus can help in managing symptoms and prolonging life. Atripla and Genvoya are two such drugs that are prescribed for this purpose. They each impact different stages of the HIV replication process, but both serve to reduce viral load and increase CD4 cell count in patients with HIV. Atripla is a combination of three antiretroviral medications: efavirenz, emtricitabine, and tenofovir disoproxil fumarate (TDF). On the other hand, Genvoya consists of four medications: elvitegravir, cobicistat (which boosts levels of elvitegravir), emtricitabine, and tenofovir alafenamide (TAF) which has less side effects on bone density and kidney function compared to TDF used in Atripla.
Atripla vs Genvoya Side By Side
| Attribute | Atripla | Genvoya |
|---|---|---|
| Brand Name | Atripla | Genvoya |
| Contraindications | Cannot be taken with certain other medicines including antifungals like itraconazole. | Cannot be taken with certain other medicines including antifungals like itraconazole. |
| Cost | $3,000 for 30 tablets | $3,500 for 30 tablets |
| Generic Name | efavirenz/emtricitabine/tenofovir disoproxil fumarate | elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide |
| Most Serious Side Effect | Mental health problems, allergic reactions, vision changes, cardiovascular issues, hyponatremia, nervous system reactions | Allergic reaction or severe skin reaction, unusual changes in mood or behavior, kidney problems, lactic acidosis |
| Severe Drug Interactions | May cause or exacerbate symptoms of depression. Must avoid certain medications due to potential dangerous interactions. | May cause or exacerbate symptoms of depression. Must avoid certain medications due to potential dangerous interactions. |
| Typical Dose | One tablet (600 mg efavirenz, 200 mg emtricitabine, and 300 mg tenofovir) taken once a day | One tablet (150 mg elvitegravir, 150 mg cobicistat, 200 mg emtricitabine, and 10 mg tenofovir alafenamide) taken orally once daily with a meal |
What is Atripla?
Atripla (efavirenz/emtricitabine/tenofovir) was the first single-tablet regimen for HIV, marking a significant advancement on previous combination therapies. It was approved by the FDA in 2006. Atripla works by inhibiting enzymes that HIV uses to replicate, effectively trapping it and preventing it from multiplying within the body. It is prescribed for managing HIV infection and requires adherence to a daily dosing schedule.
On the other hand, Genvoya (elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide), approved by the FDA in 2015, represents another step forward with an improved safety profile over Atripla. The tenofovir component of Genvoya is less likely than that in Atripla to cause kidney problems or loss of bone density—two common side effects associated with long-term use of antiretroviral therapy. Both medications are highly effective at suppressing viral load when taken as directed.
What conditions is Atripla approved to treat?
Both Atripla and Genvoya are approved for the treatment of Human Immunodeficiency Virus (HIV) infection:
- HIV-1 infection in adults and pediatric patients 12 years of age and older who have either never been treated with antiretroviral medicines or who are replacing their current antiretroviral therapy.
While both drugs help to reduce the viral load in the body, they differ in their composition. Atripla is a combination of efavirenz, emtricitabine, and tenofovir disoproxil fumarate while Genvoya combines elvitegravir, cobicistat, emtricitabine, and tenofovir alafenamide. The choice between these two may depend on several factors including patient's medical history, potential side effects among others.
How does Atripla help with these illnesses?
Atripla works to manage HIV infection by combining three different antiretroviral medications into one pill: efavirenz, emtricitabine, and tenofovir. These drugs work together to inhibit the replication of the virus within the body's cells. Specifically, they block two enzymes - reverse transcriptase and integrase - that are crucial for the reproduction of HIV in infected cells. By doing so, Atripla can limit viral load and help patients keep their immune system function stable.
Genvoya also combines multiple antiretroviral medications (elvitegravir, cobicistat, emtricitabine, and tenofovir alafenamide) with a similar aim but has some advantages over Atripla. In particular, Genvoya uses a newer form of tenofovir that is associated with less kidney toxicity and bone loss – issues often associated with long-term use of antiretroviral medication like those in Atripla. Thus it may be preferable for patients at risk for these specific conditions.
What is Genvoya?
Genvoya is a brand name for a combination of elvitegravir, cobicistat, emtricitabine, and tenofovir alafenamide. It's an integrase inhibitor-based regimen that works by preventing the virus from integrating into the genetic material of human immune cells (T-cells). This leaves the immature HIV unable to replicate and infect new cells. Genvoya has been lauded as it contains a newer form of tenofovir that is less likely to cause renal and bone density side effects compared to other forms used in treatments such as Atripla. It also includes cobicistat which enhances the effectiveness of elvitegravir by blocking an enzyme that metabolizes certain drugs in our body, allowing them to stay longer at higher levels. The addition of these components improves its efficacy while reducing potential side effects often seen with antiretroviral therapy such as kidney problems or decreased bone mineral density - common issues associated with medications like Atripla.
What conditions is Genvoya approved to treat?
Genvoya is approved for the treatment of HIV-1 infection in adults and pediatric patients, given certain conditions:
- Patients who have no antiretroviral treatment history or to replace a current antiretroviral regimen
- In those who are virologically-suppressed (HIV-1 RNA less than 50 copies per mL) on a stable antiretroviral regimen for at least six months with no history of treatment failure.
How does Genvoya help with these illnesses?
Genvoya is a combination medication containing four drugs: elvitegravir, cobicistat, emtricitabine and tenofovir alafenamide. It is commonly used to manage the symptoms of human immunodeficiency virus (HIV). Genvoya works by inhibiting the action of certain enzymes necessary for HIV replication in your body. This function helps keep the amount of HIV in your body low and increases the number of immune cells. Compared to Atripla, which also treats HIV infection but contains different active ingredients (efavirenz/emtricitabine/tenofovir disoproxil fumarate), Genvoya has been associated with fewer side effects related kidney issues and bone loss, making it more suitable for long-term use or for patients with known renal or bone conditions. Since its components have different mechanisms of action against HIV, it may be prescribed when a patient does not respond well to other antiretroviral medications like Atripla, or may be combined with such treatments if considered appropriate.
How effective are both Atripla and Genvoya?
Both Atripla and Genvoya are antiretroviral medications used in the treatment of HIV, and they were initially approved by the FDA just a few years apart. Since they contain different combinations of drugs, they may be prescribed to patients under different circumstances. The effectiveness of Atripla and Genvoya in managing HIV was directly studied in numerous clinical trials; both regimens exhibited similar efficacy in suppressing viral load as well as comparable safety profiles.
A 2010 meta-analysis on Atripla demonstrated that it is effective at achieving undetectable viral loads within the first few months of treatment, with a favorable side effect profile compared to many other antiretrovirals, and it is well-tolerated across diverse patient populations. This study also indicates that Atripla has become one of the most widely prescribed antiretroviral regimens globally due to its convenience as a single-tablet regimen.
A 2017 review indicated that Genvoya seems to be more effective than placebo at reducing viral loads and improving CD4 cell counts among individuals newly diagnosed with HIV or those switching from another therapy. Nonetheless, like any medication regime for chronic conditions such as HIV/AIDS, individual patient factors including co-existing health issues (e.g., liver or kidney disease), potential drug-interactions given other medications being taken by the patient, adherence abilities related to pill burden/side effects etc., would all need considering when prescribing these therapies.
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At what dose is Atripla typically prescribed?
Oral dosages of Atripla consist of one tablet (which contains 600 mg efavirenz, 200 mg emtricitabine, and 300 mg tenofovir) taken once a day. On the other hand, Genvoya is also administered orally but in different quantities; one tablet (containing 150 mg elvitegravir, 150 mg cobicistat, 200 mg emtricitabine, and tenofovir alafenamide) per day. For both medications it's recommended to take them on an empty stomach at bedtime to reduce side effects. It is crucial that neither medication be modified or stopped without consulting a healthcare provider as incorrect use can lead to HIV becoming resistant to treatment. Notably for children or adolescents with HIV-1 infection considering Atripla or Genvoya therapy should be under strict medical guidance with dose adjustments made according to body weight and overall health status.
At what dose is Genvoya typically prescribed?
Genvoya treatment is typically initiated with a dosage of one tablet taken orally once daily. Each Genvoya tablet contains 150 mg of elvitegravir, 150 mg of cobicistat, 200 mg of emtricitabine, and 10 mg of tenofovir alafenamide. It's essential to take this medication in the context of a meal for maximum absorption and efficacy. The dose remains constant regardless of how long you've been on the medication or your response to it - there is no increase over time as seen in other treatments. This regimen has proven effective at suppressing viral replication in those with HIV-1 without previous antiretroviral treatment history.
What are the most common side effects for Atripla?
Typical side effects of Atripla may include:
- Dizziness, headache
- Difficulty sleeping (insomnia)
- Skin rash or itching
- Nausea and vomiting
- Diarrhea
- Fatigue or tiredness (asthenia)
- Abnormal dreams
- Depression, anxiety
On the other hand, Genvoya may cause:
- Nausea
- Diarrhea
- Headache
- Tiredness (fatigue) -Skin rash or changes in skin coloration on palms/soles of feet.
Remember that everyone's body responds differently to medication. If you experience any adverse effects from treatment, consult with your healthcare provider immediately.
Are there any potential serious side effects for Atripla?
Atripla and Genvoya are both antiretroviral therapies used to treat HIV. However, they can cause different side effects in some individuals:
- Mental health problems: Both medications may lead to depression or anxiety, which could potentially increase thoughts of suicide or self-harm.
- Allergic reactions: Either drug can trigger a severe allergic reaction, with symptoms such as hives, difficulty breathing, swelling in the face or throat, fever and sore throat.
- Vision changes: Atripla might cause vision changes like blurring or seeing halos around lights. Genvoya doesn't typically affect vision but if it does occur contact your healthcare provider immediately.
- Cardiovascular issues: Fast or pounding heartbeats, fluttering in the chest and sudden dizziness have been reported by some patients using either medication.
- Hyponatremia (low sodium levels): This is rare but possible with either drug; signs include headache, confusion, slurred speech and loss of coordination.
- Nervous system reactions: In rare cases these drugs may result in severe nervous system responses - rigid muscles or tremors - accompanied by high fever and sweating.
If you experience any of these symptoms while taking Atripla or Genvoya seek immediate medical attention.
What are the most common side effects for Genvoya?
When taking Genvoya, here are some potential side effects you may experience:
- Nausea or upset stomach
- Changes in weight and body fat distribution
- Diarrhea
- Headache
- Fatigue or weakness
- Dizziness
- Trouble sleeping (insomnia)
- Skin rash
- Mild itching
Remember that this is not a comprehensive list and it's important to consult with your healthcare provider about any unusual symptoms.
Are there any potential serious side effects for Genvoya?
When comparing Atripla to Genvoya, it's important to note that while both are effective treatments for HIV, there can be some serious side effects with Genvoya. These may include:
- Signs of an allergic reaction or severe skin reaction: hives, itching, fever, swollen glands, difficulty breathing and swelling in your face or throat
- Unusual changes in mood or behavior
- Kidney problems: increased thirst and urination; weakness; constipation; confusion; abnormal heart rhythm
- Lactic acidosis (high level of lactic acid in the blood), which includes symptoms like fast breathing, unusual muscle pain and stomach discomfort.
It is essential that you contact your healthcare provider immediately if any of these symptoms arise after starting a regimen with Genvoya.
Contraindications for Atripla and Genvoya?
Both Atripla and Genvoya, as with most other antiretroviral medications, may cause or exacerbate symptoms of depression in some people. If you notice your mood worsening, or an increase in suicidal ideation, thoughts, or behavior while on these treatments for HIV/AIDs , please seek immediate medical attention.
Neither Atripla nor Genvoya can be taken if you are using certain other medicines including antifungals like itraconazole. Always tell your physician which medications you are taking; this is especially important because the drugs contained within Atripla and Genvoya interact with many different types of medications to varying degrees. Some of these substances will require a period without use before starting either Atripla or Genvoya to prevent dangerous interactions.
How much do Atripla and Genvoya cost?
For the brand name versions of these drugs:
- The price for 30 tablets of Atripla (600 mg) averages around $3,000, which works out to approximately $100/day.
- The cost for a month's supply (30 tablets) of Genvoya is about $3,500, or roughly $117/day.
Thus, if you are comparing costs alone and not considering individual health needs or potential side effects, then brand-name Atripla is less expensive on a per-day treatment basis than Genvoya. However, remember that cost should not be the primary consideration in determining which HIV medication is best for you.
As for generic versions of these medications:
- As yet there are no approved generic equivalents available in most countries including USA due to patent protections held by their respective manufacturers. This situation may change once those patents expire.
Popularity of Atripla and Genvoya
Atripla, a combination of three antiretroviral medications (efavirenz, emtricitabine and tenofovir disoproxil fumarate), was estimated to have been prescribed to roughly 155,000 people in the US during 2020. Atripla accounted for approximately 7% of all prescriptions for HIV/AIDS medication within that year. However, its prescription rate has been gradually decreasing since around 2013 due to the development of newer drugs with fewer side effects.
Genvoya on the other hand is an updated version of Atripla containing elvitegravir, cobicistat, emtricitabine and tenofovir alafenamide. It was prescribed to about 300,000 patients in the USA in 2020 alone. Genvoya accounts for nearly half (42%) of integrase inhibitor-based regimens which are popular due their high efficacy and low toxicity profile hence their increased use over time since approval by FDA in late 2015. The prevalence of Genvoya has been steadily increasing as it presents a safer option than older therapies such as Atripla.
Conclusion
Both Atripla and Genvoya have proven records of effectiveness in patients with HIV, as demonstrated by numerous clinical studies indicating that they are more successful than other treatments at suppressing viral load. Sometimes these medications may be utilized together, but this decision is subject to careful review by a healthcare provider due to potential drug interactions. They work via different mechanisms - Atripla contains efavirenz, emtricitabine and tenofovir disoproxil fumarate which act on various stages of the HIV life cycle while Genvoya comprises elvitegravir, cobicistat, emtricitabine and tenofovir alafenamide with each component targeting a specific phase of the virus replication process.
Atripla has been around longer; thus it's often considered as an initial treatment option for newly diagnosed patients who don't exhibit resistance to any of its components. On the other hand, Genvoya may be preferred for those who haven't responded well to first-line therapies or need to avoid certain side effects such as kidney complications and bone density loss associated with older antiretroviral drugs like Atripla.
Both medications come in single pill form combining multiple agents – providing convenience especially for individuals paying out-of-pocket. The adjustment period varies among patients; therefore noticeable improvements might not occur immediately after starting therapy.
The adverse effect profile is comparable between both drugs; however, Genvoya tends to cause fewer central nervous system disturbances (like dizziness or insomnia) compared to Atripla’s efavirenz component. For all regimens involving antiretroviral drugs including Atripla and Genvoya, diligent monitoring of overall health status is crucial since HIV directly impairs immune function.
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Refrences
- 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
- Greig, S. L., & Deeks, E. D. (2016, May 17). Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide: A Review in HIV-1 Infection. Drugs. Springer Science and Business Media LLC.http://doi.org/10.1007/s40265-016-0586-z
- Gaur, A. H., Kizito, H., Prasitsueubsai, W., Rakhmanina, N., Rassool, M., Chakraborty, R., … Rhee, M. S. (2016, December). Safety, efficacy, and pharmacokinetics of a single-tablet regimen containing elvitegravir, cobicistat, emtricitabine, and tenofovir alafenamide in treatment-naive, HIV-infected adolescents: a single-arm, open-label trial. The Lancet HIV. Elsevier BV.http://doi.org/10.1016/s2352-3018(16)30121-7
- Anene, Bentley, Broder, M., Ortendahl, J., Juday, T., & Correll, T. (2013, September). Cost-effectiveness of the once-daily efavirenz/emtricitabine/tenofovir tablet compared with the once-daily elvitegravir/cobicistat/emtricitabine/tenofovir tablet as first-line antiretroviral therapy in HIV-infected adults in the US. ClinicoEconomics and Outcomes Research. Informa UK Limited.http://doi.org/10.2147/ceor.s47486
- Natukunda, E., Gaur, A. H., Kosalaraksa, P., Batra, J., Rakhmanina, N., Porter, D., … Rhee, M. S. (2017, September). Safety, efficacy, and pharmacokinetics of single-tablet elvitegravir, cobicistat, emtricitabine, and tenofovir alafenamide in virologically suppressed, HIV-infected children: a single-arm, open-label trial. The Lancet Child & Adolescent Health. Elsevier BV.http://doi.org/10.1016/s2352-4642(17)30009-3
- Godinho, R., Bugnon, S., Gracin, T., & Tataw, J. (2019, February 26). Severe rhabdomyolysis-induced acute kidney injury following concomitant use of Genvoya® (EVG/COBI/FTC/TAF) and simvastatin; a case report. BMC Nephrology. Springer Science and Business Media LLC.http://doi.org/10.1186/s12882-019-1257-6