Tenofovir alafenamide has allegedly milder side effects than tenofovir disoproxil. It’s softer on kidneys and bones. Why don’t the doctor’s prescribe the better version straight away then?
Porque TAF no está en genérico, todavía tiene la patente.
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Hi @Arb,
It comes down to cost, insurance and availability. This medicine is not available in every market. It is very expensive and sometimes insurance company’s won’t cover it. That is why it might not be prescribed straight away. There is the problem. Best, Bansah1.
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@Bansah1 is correct. It is economics at play, not medicine. However, for the large majority of people, TDF is as effective and safe as TAF. TAF’s benefits are primarily in the relatively small number of people who have side effects and cannot switch to entecavir for some reason.
John.
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Thank you. As I wrote elsewhere, I have osteopenia. I'm afraid of osteoporosis as a side effect of tenofovir I have begging of osteopenia. And this even before starting the treatment. The doctor has prescribed me TDF nonetheless. I’d like to advocate for TAF on the next appointment.
Where I live, the country covers medication, so I’m afraid they could see it as a ‘burden’ on national healthcare to prescribe expensive TAF.
I’m afraid this might be the reason, or I’m too suspicious.
Either way, I don’t want to wait until my bones get unrecoverably thinner and weaker. What arguments can I use?
Present them with the data about TAF. TAF was developed in large part to improve treatment in osteoporotic persons and people with limited kidney function. I believe it even says in most major liver society guidelines that TAF is the preferred drug when osteoporosis is present in a patient.
John
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You can explain your concerns about this to the provider just as you have done here and they should understand. It makes sense not to put you on TDF if you are already having some bone related issues. Entecavir is another antiviral medicine that you can use. It works well just as TDF AND TAF. You have that option as well if they won’t cover TAF.
Best and keep us posted on how things go.
Bansah1.
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I believe TDF affect people who are severely underweight, if you have osteopenia and kidney functions are normal , the cost for TDF is affordable TAF is expensive. Make sure your weight is normal
@john.tavis @Bansah1
Thank you. I will do so.
@Ccheng8346
I have normal weight, thank you. I also weightlift in order to strengthen the muscles and bones.
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Sometimes the TAF is more expensive than TDF and not everybody can afford it.and most insurance can’t give all the TAF for their enrollees
It may also be worthwhile considering entecavir in this case.
Thomas
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Same question with OP and I don’t currently have bone/kidney related issues.
I was recommended to start medication with 50+ ALT and 9K+ HBV DNA Quant. My doctor prescribed TDF. They commented on TDF being out there longer than TAF and they have not heard much side effects reported from patients.
I have read of several posts in the forum on TDF effects on bones and kidneys. I’m 33. My question is, should I just ask the doctor to prescribe me TAF straight? I think my insurance can cover most of it (for now), and I’m afraid TDF will cause me those bones/kidney issues long term, as I age. I assume they are irreversible issues?
Hi @sky101,
Welcome to the community. The side effects you mention do not happen to every patient that takes TDF. But if you have access, more comfortable with TAF and your insurance will cover it, sure you can ask your doctor for it. Best, Bansah1
Dear @sky101,
There still is a of confusion on the forum regarding TDF vs TAF.
As I and my colleagues have mentioned elsewhere on the forum, mild bone demineralization or mild reduction in kidney function occurs in a small (but not insignificant) fraction of patients after many years of TDF therapy. In most of these cases there are no actual symptoms and these changes reported in clinical trials but are not really medically relevant. For those who develop real side effects from these impacts, TDF can be switched to therapy every other day to alleviate these symptoms in most cases with no alteration in antiviral impact.
For some patients, these symptoms may require transition to TAF or ETV (the latter is also cheaply available worldwide). There are even some patients who develop bone demineralization which is not improved by TAF.
In the end, if your insurance will cover it, you can use TAF but they may say to take TDF until issues present themselves and then switch to TAF. TAF is very expensive as it is still under patent protection.
I believe switching to TAF from TDF increased my Total Cholesterol and LDL (10-20%) and likely my weight. This effect has also been described in recent literature. I am thinking of switching back to TDF. Anyone else with similar issues?
Ace
Hi @Ace,
Yes, I have observed that as well. I recently had a conversation with my provider about maybe switching to Entecavir since I am at the point where my primary care provider wants me to consider taking statin because my number keeps going up. If it is the cause and switch will avoid me taking stations, then yes I will do that. It seems to be more common as more patients talk about this issue. If you were fine on TDF, then have a conversation with your doctor about your concern and see if switching is the best option for you. Best, Bansah1
Thanks @Bansah1, yes I was OK on TDF. I have never had issues with cholesterol before that and both antivirals I have been on over the years, Hepsera (adefovir) and TAF, have been fine in leading to undetectable HBV DNA, but I decided to switch to TAF because it was supposed to be safer.
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