What are the side effects of Descovy (emtricitabine and tenofovir alafenamide)?

From the Guidelines

Descovy, a combination of emtricitabine and tenofovir alafenamide, has been shown to have a more favorable side effect profile compared to older tenofovir formulations, with fewer tenofovir-associated toxic effects such as proximal renal tubular toxicity and reductions in bone mineral density 1. When considering the side effects of Descovy, it is essential to weigh the benefits of the medication against the potential risks. Common side effects may include nausea, diarrhea, headache, fatigue, and abdominal pain. However, more serious side effects that require immediate medical attention, such as lactic acidosis, liver problems, kidney problems, and immune reconstitution syndrome, are less common. Some key points to consider about the side effects of Descovy include:

• Compared to TDF, TAF (tenofovir alafenamide) yields a lower plasma level of tenofovir and higher intracellular concentration of the active antiviral component tenofovir diphosphate, resulting in fewer tenofovir-associated toxic effects 1.
• TAF has little or no effect on bone density and little or no kidney toxicity, with no cases of clinical renal disease directly ascribed to TAF to date 1.
• The daily dose of TAF is lower than that of TDF, and TAF is currently available only in coformulations, including emtricitabine/TAF 1. It is crucial for patients to take Descovy exactly as prescribed and attend all follow-up appointments for monitoring, which may include blood tests to check kidney function and bone density scans periodically.

From the Research

Descovy Side Effects

The side effects of Descovy (emtricitabine and tenofovir alafenamide) are primarily related to renal and bone safety.

• Renal side effects:
  • Tenofovir alafenamide has been shown to have a more favorable renal safety profile compared to tenofovir disoproxil fumarate 2, 3, 4.
  • However, some studies have reported a decline in renal function in patients switched from tenofovir disoproxil fumarate to tenofovir alafenamide 5.
• Bone side effects:
  • Tenofovir alafenamide has been associated with improved bone mineral density (BMD) compared to tenofovir disoproxil fumarate 2, 3, 4.
  • However, one study reported discordance in spine BMD, with initial improvement at 24 weeks but regression at 72 weeks 5.
• Other side effects:
  • Weight gain and increase in body mass index (BMI) have been reported in some patients switched to tenofovir alafenamide 5.
  • Serious adverse events, such as renal colic, neutropenia, and myocardial infarction, have been reported in a small number of patients 2.

Comparison to Tenofovir Disoproxil Fumarate

• Tenofovir alafenamide has been shown to have a more favorable renal and bone safety profile compared to tenofovir disoproxil fumarate 2, 3, 4.
• However, tenofovir disoproxil fumarate may still be a viable option for some patients, particularly those without renal or bone toxicity concerns.

Patient Outcomes

• Patients who switch from tenofovir disoproxil fumarate to tenofovir alafenamide may experience improved renal and bone outcomes 2, 3, 4.
• However, long-term studies are needed to evaluate the effects of weight gain and other potential side effects on patient outcomes 5.