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Author Topic: GENVOYA, DOVATO or JULUCA?  (Read 1524 times)

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Offline frederick

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GENVOYA, DOVATO or JULUCA?
« on: November 01, 2019, 06:14:11 am »
Hi! I'm thinking of switching meds and have the following options:

GENVOYA (elvitegravir, cobicistat, emtricitabine, and tenofovir alafenamide)

DOVATO (Dolutegravir and Lamivudine)

JULUCA (Dolutegravir and Rilpivirine)
 
I'm currently on SYMFI (efavirenz, lamivudine and tenofovir disoproxil fumarate)

My main consideration for the switch is to protect my kidneys from TDF toxicity and to minimize neurological issues due to EFV. I was almost certain to go with DOVATO but had to think twice when I read that DOVATO is not recommended for people with creatinine clearance (CrCl) of less than 50 ml / min.. While Genvoya, which contains TAF, is not recommended for people with CrCl of less than 30 ml/min.. How is GENVOYA safer for the kidneys if it contains TAF? Which component of DOVATO is nephrotoxic?

BTW, I got the information from this website:
https://www.positivelyaware.com/drug-guides/genvoya
https://www.positivelyaware.com/drug-guides/dovato

TIA for your replies :)


Offline Jim Allen

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Re: GENVOYA, DOVATO or JULUCA?
« Reply #1 on: November 01, 2019, 07:25:39 am »
Quote
I was almost certain to go with DOVATO but had to think twice when I read that DOVATO is not recommended for people with creatinine clearance (CrCl) of less than 50 ml / min

Not sure I get the concern, do you have pre-existing kidney issues?

Here it's measured every 6 months so if there were any issues I could step in before it's a problem. Does your doc not monitor this?
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Offline frederick

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Re: GENVOYA, DOVATO or JULUCA?
« Reply #2 on: November 01, 2019, 08:53:36 am »
Not sure I get the concern, do you have pre-existing kidney issues?

Here it's measured every 6 months so if there were any issues I could step in before it's a problem. Does your doc not monitor this?

Hi Jim. Yes. My kidney function is tested every so often. So far, my serum creatinine has been in the normal range.. I worry more about my potassium level which, while still in the normal range, has been steadily going down. My 24h urine potassium is also in the upper end of the normal range. I have symptoms similar to that of potassium wasting / electrolyte imbalance. Urine is also very foamy (think beer foam). I can only surmise that the TDF in Symfi is what's causing my issues.

My doctor has given me the green light to switch. I will be flying to bkk soon to buy either of the 3 options stated above. I'm currently weighing my options so I know what to go with.

As mentioned in my first post, I just want to know why genvoya, despite containing TAF, is deemed safer for the kidneys than dovato?  Which between DTG and 3TC component in Dovato may cause kidney issues?

Offline Jim Allen

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Re: GENVOYA, DOVATO or JULUCA?
« Reply #3 on: November 01, 2019, 09:09:38 am »
Well if the doctor has given the green light and you don't have pre-existing issues than I would personally would not worry about issues that don't apply to me. 

Quote
why genvoya, despite containing TAF, is deemed safer for the kidneys than dovato?

Help me out here, do you have a reference Dovata vs TAF and was this in relation to overall or people with Pre-existing issues?

I have plenty on TAF vs TDF and also the doubts raised on these claimed improvement
« Last Edit: November 01, 2019, 09:12:01 am by Jim Allen »
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Offline Expat1

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Re: GENVOYA, DOVATO or JULUCA?
« Reply #4 on: November 01, 2019, 05:45:41 pm »
If flying to Bangkok then only one of those  options is available: Genvoya.

The others are not yet available in Thailand.

Offline frederick

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Re: GENVOYA, DOVATO or JULUCA?
« Reply #5 on: November 02, 2019, 07:52:42 am »
Well if the doctor has given the green light and you don't have pre-existing issues than I would personally would not worry about issues that don't apply to me. 

Help me out here, do you have a reference Dovata vs TAF and was this in relation to overall or people with Pre-existing issues?

I have plenty on TAF vs TDF and also the doubts raised on these claimed improvement

Hi Jim.  As mentioned in my first post, I got the information from the following links:

https://www.positivelyaware.com/drug-guides/genvoya
"Genvoya is not recommended for people who have severe liver problems, a CrCl between 15 to 30 mL/min, or a CrCl less than 15 mL/min who are not receiving chronic hemodialysis."

https://www.positivelyaware.com/drug-guides/dovato
"Dovato is not recommended for people with CrCl less than 50 mL/min or who have severe liver impairment."

If I understand the above information correctly, it would seem Genvoya is safer for the kidneys.  I am aware that TAF, although claimed to be safer than TDF by the manufacturer, can still cause kidney issues in some people. This is why I'm wondering why Genvoya is deemed safer for people with kidney issues than Dovato which contains no tenofovir..

Offline frederick

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Re: GENVOYA, DOVATO or JULUCA?
« Reply #6 on: November 02, 2019, 07:57:42 am »
If flying to Bangkok then only one of those  options is available: Genvoya.

The others are not yet available in Thailand.

Hi Expat. Yes. I'm aware that DOVATO is not available as a single pill in Bangkok.. My plan is to purchase DTG and 3TC separately if ever I decide on going with Dovato. Are you based in Bangkok?

Offline Jim Allen

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Re: GENVOYA, DOVATO or JULUCA?
« Reply #7 on: November 02, 2019, 09:20:52 am »
Hi Jim.  As mentioned in my first post, I got the information from the following links:

https://www.positivelyaware.com/drug-guides/genvoya
"Genvoya is not recommended for people who have severe liver problems, a CrCl between 15 to 30 mL/min, or a CrCl less than 15 mL/min who are not receiving chronic hemodialysis."

https://www.positivelyaware.com/drug-guides/dovato
"Dovato is not recommended for people with CrCl less than 50 mL/min or who have severe liver impairment."

If I understand the above information correctly, it would seem Genvoya is safer for the kidneys.  I am aware that TAF, although claimed to be safer than TDF by the manufacturer, can still cause kidney issues in some people. This is why I'm wondering why Genvoya is deemed safer for people with kidney issues than Dovato which contains no tenofovir..

So I don't doubt the numbers just the interpretation. As said it seems to be just the standard potentially worsening of people with (pre-existing) severe renal impairment, does not automatically equate cause in or additional (abnormal) strain levels in otherwise healthy people. 

I'm on the mobile phone so can't find the reference but I do recall a few reports showing that switching or starting Tivicay can cause an additional but temporary increase in serum creatinine levels. I'll have a look tonight when I am back on the laptop to confirm that though.

End of the day, even TDF I would not class as toxic. It has a bad rep but people have and still do take it for many years and are fine with close monitoring, it's unfortunate the management of this drug was not great and this due to a number of factors it left gaps in care hurting some. Whatever you ultimately choose as a combination, I wish you all the best and try not to overly worry as long as you are being monitored correctly and you have your doctors blessing.

Take it easy.

Jim





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Offline Expat1

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Re: GENVOYA, DOVATO or JULUCA?
« Reply #8 on: November 02, 2019, 11:38:28 am »
I think the problem with TDF was that they left the dosage at 300mg for people who used PIs.  With TAF the dose is reduced from 25  mg to 10 mg when using a booster.

Offline Jim Allen

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Re: GENVOYA, DOVATO or JULUCA?
« Reply #9 on: November 04, 2019, 05:38:21 am »
Quote
I'm on the mobile phone so can't find the reference

Hi Frederick,

Sorry for not getting back sooner. Below is what I had most recently been reading on this topic. I liked it as I found it was comprehensive in its review and under data it had a few of the drugs listed in a sheet that I found handy.

Anyhow just wanted to close the loop on my post as I had mentioned a reference. I took a screenshot of the chart I liked so you know what I mean, anyhow maybe the article will assist you.
 
Wishing you all the best, Jim

Mohamed G. Atta, Sophie De Seigneux and Gregory M. Lucas
CJASN October 2018, CJN.02240218; DOI: https://doi.org/10.2215/CJN.02240218


« Last Edit: November 04, 2019, 05:48:53 am by Jim Allen »
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Offline frederick

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Re: GENVOYA, DOVATO or JULUCA?
« Reply #10 on: November 04, 2019, 07:57:44 am »
Hi Frederick,

Sorry for not getting back sooner. Below is what I had most recently been reading on this topic. I liked it as I found it was comprehensive in its review and under data it had a few of the drugs listed in a sheet that I found handy.

Anyhow just wanted to close the loop on my post as I had mentioned a reference. I took a screenshot of the chart I liked so you know what I mean, anyhow maybe the article will assist you.
 
Wishing you all the best, Jim

Mohamed G. Atta, Sophie De Seigneux and Gregory M. Lucas
CJASN October 2018, CJN.02240218; DOI: https://doi.org/10.2215/CJN.02240218



Hi Jim. The article is indeed very helpful.. I guess it's now down to my doctor to decide which combination would suit me best. Thank you for taking the time to answer my queries :)

Offline Jim Allen

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Re: GENVOYA, DOVATO or JULUCA?
« Reply #11 on: November 04, 2019, 01:00:54 pm »
You're welcome.
HIV 101 - Everything you need to know
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Transmission and Risks:
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