Genvoya is a combination tablet containing elvitegravir, cobicistat, emtricitabine and tenofovir alafenamide, for the treatment of HIV-1 infection. It can be used in patients over 12 years of age and weighing at least 35kg who have no resistance mutations to integrase inhibitors, emtricitabine or tenofovir.
Tenofovir alafenamide is a prodrug of the nucleotide reverse transcriptase inhibitor tenofovir. It is more efficient than tenofovir disoproxil fumarate in concentrating tenofovir in peripheral blood mononuclear cells and macrophages, where HIV-1 replicates.
Elvitegravir, cobicistat and emtricitabine have already been shown to be effective. Elvitegravir is an HIV integrase inhibitor; cobicistat is a cytochrome P450 3A inhibitor that has no anti-HIV activity but acts as a pharmacoenhancer allowing once-daily dosing; and emtricitabine is a nucleoside reverse transcriptase inhibitor.
Low tenofovir dose
The new combination tablet delivers the same antiviral effect as the elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate tablet (Stribild) but at a lower dose of tenofovir, resulting in reduced drug concentrations in the bloodstream. Studies showed regimens containing tenofovir alafenamide were associated with improvements in laboratory markers of renal and bone safety compared with regimens containing tenofovir disoproxil fumarate.
Genvoya is supplied as 150mg/150mg/200mg/10mg fixed-dose tablets.