If TAF is better than TDF, why don't they prescribe it straight away?

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.


@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.



@Bansah1 @john.tavis

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.


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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.

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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.

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.


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