Anyone switch from Truvada to Descovy?

[tallslenderguy]

Here's an excerpt from an article in the pharmaceutical publication Pharmacy Times on the two different forms of tenofovir  I.e.  Tenofovir disoproxil fumarate (TDF) an ingredient  in Truvada and  tenofovir alafenamide (TAF) an ingredient in Descovy. 

Issues with TDF
Despite TDF’s being the most commonly prescribed ARV and a recommended component of most HIV treatment regimens, TDF presents several safety concerns.^1,2  First, all ARVs formulated with TDF have warnings in their prescribing information for new-onset or worsening renal impairment. How this occurs is still debated, but it’s believed to be due to TDF’s toxicity to mitochondria in the proximal tubule, which leads to impaired reabsorption of low-molecular-weight proteins and other solutes.¹
 
Consequently, physicians should assess creatinine clearance in all individuals prior to initiating therapy and assess additional lab parameters in those with previous renal events. TDF isn’t recommended for concurrent or recent use of nephrotoxic drugs (eg, high-dose or multiple NSAIDs, or aminoglycosides).
 
The incidence of renal toxicity with TDF use is relatively low and it’s seen to be comparable with other nucleotide reverse transcriptase inhibitors (NRTI) in clinical trials.³ Despite this, there are many case studies and small case series of renal dysfunction with TDF.
 
A second safety concern with TDF involves its effects on reducing bone mineral density (BMD). The potential mechanism for this effect is unclear; however, it may result from proximal renal tubular dysfunction causing hypophosphatemia. More recently, TDF was reported to alter both osteoblast gene expression and function.⁴
 
In clinical trials in HIV-1 infected adults and in a clinical trial of HIV-1 uninfected individuals, TDF was found to be associated with slightly greater decreases in BMD and increases in other biochemical markers of bone metabolism, suggesting increased bone turnover relative to comparator. The long-term effects of TDF on bone health and fracture risk is unknown.
 
According to the prescribing information for TDF products, assessment of BMD should be considered for adult and pediatric patients who have a history of pathologic bone fracture or other risk factors for osteoporosis or bone loss.
 
How TAF Works

Like TDF, TAF is a, NRTI. It's a pro-drug of tenofovir, specifically designed to circulate systemically and undergo most of its conversion to tenofovir intracellularly. This results in higher active metabolite levels within HIV-infected cells and lower plasma levels. Within the cells, it inhibits the activity of HIV reverse transcriptase by competing with natural substrates and causing DNA chain termination after being incorporated into viral DNA.⁵
 
The major difference with TDF is that it has much higher plasma tenofovir exposure, which leads to some of the safety concerns. In fact, TAF in Genvoya is formulated as one-tenth the dose of TDF in Stribild, which results in a 90% lower circulating tenofovir plasma concentration. This results in less renal dysfunction and issues with BMD.⁶

^{[think before following links] https://www.pharmacytimes.com/contributor/timothy-o-shea/2016/10/what-every-pharmacist-should-know-about-tenofovir-alafenamide}

[tallslenderguy]

On 12/9/2019 at 8:22 AM, wood said:

My main concern is the efficacy of tenofovir alafenamide in the new version... the elimination half life is incredibly short compared at just around a half an hour, where TDF has a half life of 17 hours.   Basic logic seems to say that if it’s eliminated that much quicker you have much less room for error in when you take the medication. 

i'm not a pharmacist, so not able to offer info from that professional perspective.  But here's an excerpt from the article i cited earlier that may help? 

Like TDF, TAF is a, NRTI. It's a pro-drug of tenofovir, specifically designed to circulate systemically and undergo most of its conversion to tenofovir intracellularly. This results in higher active metabolite levels within HIV-infected cells and lower plasma levels.

my understanding is the improved renal function is a result of putting more of the efficacious elements intracellular where it inhibits HIV reproduction vs circulating in the blood where it has deleterious effects on the kidneys?

[Guest rookie-69]

1 hour ago, tallslenderguy said:

Interesting.  Could you cite the data supporting your claims please?   

[think before following links] https://podcasts.apple.com/us/podcast/the-daily/id1200361736?i=1000440662002

[Guest rookie-69]

6 hours ago, BackroomHole said:

How can anyone trust the new York times? 

If the main stream media is 99% propaganda and lies you shouldn't trust your life on anything they say or post.

The paper has been around nearly 170 year.  It’s won 127 Pulitzer’s and 5 Peabody awards.  While you can have your own opinion about its editorial side, it’s reporting and reporters have always been considered the best standard.  Like all news sources it has had its failures.  If you look at where those failures have been it is usually burying negative stories about military intervention for fear of national security.  And the podcast centers around an interview with the researcher that created Prep.  I’d say that is a reliable source.

[tallslenderguy]

1 hour ago, rookie-69 said:

[think before following links] [think before following links] https://podcasts.apple.com/us/podcast/the-daily/id1200361736?i=1000440662002

This is an excellent and informative pod cast, but it doesn't answer my question.  It addresses the greed of pharmaceutical companies, which i have railed against for years as a healthcare professional. my personal belief is that pharmaceutical research should not be privitized.  If we took the scientists who discover meds like Truvada and Descovy, gave them a 10% raise, our cost to develop drugs would still be half by removing the profit element.  It would be even less when you remove patents that sustain obscene profiteering.  

The claim was: 

"Truvada is superior over Descovy when it comes to PrEP 

trust me I’ve seen the data "

I have not seen research evidence to support this claim.  To my way of thinking, Descovy should have he patent removed and made readily available as PreP, because  at this point the evidence points to it being as efficacious and having fewer deleterious side effects.  Truvada costs about $60 a year to make, i am guessing Descovy is probably about as cheap,  yet Gilead wants to charge $20,000. 

[PG1961Canada]

On 12/10/2019 at 4:33 PM, tallslenderguy said:

This is an excellent and informative pod cast, but it doesn't answer my question. 

The claim was: 

"Truvada is superior over Descovy when it comes to PrEP 

trust me I’ve seen the data "

I have not seen research evidence to support this claim.  

Good poing... and I agree it is CLEAR that Gilead is planning ahead.  And the rules will be different for every country the sale their product.  Whole different issue.  It sucks for sure.  That was a good podcast.. but it was around 'greed'.  And the complications of 'who paid for what part of development?'.  It will be a fight.  But I would like to think people are more aware it makes more sense to prevent ANY illness than cure it.   I am very fortunate - my drug plan will cover either... as an insurer, they would love to have me on generic Truvada (available already in Canada) vs. newer more expensive Descovy.

But even after reading a lot of literature, I still think it is the best move for me.  Personally.  My Doc sits and talks to me about this stuff.  He told me at my last appointment that he was recommending the change.  Find out if my plan was going to cover it (they are) and think about it for my next appointment and he will answer any questions I have..... hence my request to the community.  I've found almost ALL comments very thought out and people pretty open and honest.... and ya.. we don't all agree.  Hence my comment "personally'.

I have definitely read everyone's comments.... people are saying a lot of what I am reading.  I AM curious though when one of our members says Truvada is superior.... I am not seeing that anywhere.  One of our fellow members did have a point about TAF and 'timing'... but that is one of the questions I'll throw at my Doc after Christmas. 

So with the exception of the ..."trust me I've seen the data".... if there is data that I'm not finding... could you please point it out... I'm certainly very interested to hear a different view!

 

Again - thanks to all for a good thread.  Much appreciated.  

[Bttm2go]

I checked my numbers over the last three years. My eGFR started at 93 had a high of 97 and then started falling to a low of 79 just as I switched to Descovy. I am now up to 90 0n my last test. It will be interesting to keep following this.

[wildbottom]

FYI, Dynamix has generic Descovy as well as generic Truvada. I've checked - and random independent testing has shown that the versions Dynamix sells are made in the same factory, just bound for other global regions. My last four 3 month supplies have all come branded for Singapore.

I pay $69 for a three month supply, shipped for free. purchase-prep.com

 

[Bttm2go]

I was on truvada for three years. My doctor switched me over to descovy. Have not noticed a difference other than the pill is smaller. 

[120DaysofSodom]

 

On 11/29/2019 at 12:27 AM, rawwhitebottom said:

As a specialist in the field please men 

do not be fooled 

stay on Truvada 

it’s all a fucking money move by Gilead

Truvada is superior over Descovy when it comes to PrEP 

trust me I’ve seen the data 

do not fall into their marketing bullshit 

 

I completely disagree. Truvada made me sick as a dog for months when I first started taking it years ago. The side effects were so bad I eventually just said fuck this and stopped.

Now that im POZ I am on Biktarvy which has Descovy in it and I suffer ZERO side effects from the Biktarvy.

Descovy is far superior.

[bgr745]

I made the switch a few months ago and haven’t noticed any differences. The smaller pill size is nice though! 

[drscorpio]

I saw my doctor today. As soon as the new pills arrive, I am switching. 

[Guest NSAFUCKBUD]

The initial prescription I was given is Descovy.  Never given Truvada as an option.  I am a Top and understand my risk of seroconverting is low but I like the peace of mind I get from having the added protection of PREP.  

[Guest LexGS]

My last conversation with my Dr. about Truvada as PreP (which I have been on for several years) with no side effects and maintaining regular blood work for both STD's, liver, kidney, etc.  I have never had a problem or any changes in my blood work to indicate that I should change, however she was "aggressively encouraging" me to change to Descovy.  I asked the typical questions about the medication and figured if there was no harm and she had a good reason then I don't have a problem changing.  I was on Descovy for 3 days with no problems then the 4th day and I felt like I got hit by a truck (lethargic, brain fog, etc.).  I notified the Dr. and she had no problem switching me back to Truvada.  My purpose in this story is

1. Always be an informed consumer, never be afraid to ask questions.
2. If you feel you have ANY adverse effects call your Dr. immediately, if they don't answer...find a new Dr.
3. If the reason is "It's just better", that's not a good reason.

I saw some posts about it all being for the money, I work in healthcare but I am NOT a doctor or medical professional IN ANY WAY, I actually deal with the financial sides of things.  The financial and medical reasons for companies to release new medications to "replace" or are "better" than existing are numerous and we could have a long discussion.

I take a migraine medication Treximet which is the only thing that works (I tried a lot of them), it was prescribed to me when it was new cost was ($25 p/ pill).  Treximet is the combination of Imitrex and Naproxen (sp?) both of which are old medications and I tried both independently and together with no effect or negative effects.  However, in the blending of the medications it works really well (for me).  The Dr. I had at the time was "old school", so I asked what was the difference...why did the pill work and not the drugs separately (which was a lot cheaper).  She told me that with some medications when they combine them it changes how they function and not an obvious effort to create a new drug.  She was not one for the "latest pill" but what was best for her patients.  I even saw her toss out a pharma rep because he was trying to get her to use their "new" medication, she looked and said "you added aspirin" and my patients don't need to pay for that.

That's my 2 cents.

[tboyer]

I tried Truvada, (not as Prep) and it gave me very bad pounding headaches and high blood pressure. My doctor tried to convince me it was all in my head (pun intended )

Well...she is no longer my doctor and I went to another. It is amazing how bad some doctors can be