From the Guidelines
Truvada and Descovy are both highly effective for HIV pre-exposure prophylaxis (PrEP), but Descovy may be preferred for individuals with kidney issues or bone concerns due to its more favorable safety profile, as noted in the 2020 recommendations of the international antiviral society-usa panel 1. The efficacy of Truvada (emtricitabine/tenofovir disoproxil fumarate) and Descovy (emtricitabine/tenofovir alafenamide) for PrEP is similar, with no significant difference in efficacy rates, according to the study published in JAMA 1. Some key points to consider when choosing between Truvada and Descovy include:
- Descovy is recommended for the subset of men who have sex with men (MSM) with a creatinine clearance rate between 30 mL/min and below 60 mL/min who have a history of osteopenia or osteoporosis, or who are at high risk for these complications, as stated in the study 1.
- The study also notes that daily tenofovir alafenamide/emtricitabine is recommended for this specific subset of MSM, but the efficacy of tenofovir alafenamide/emtricitabine is not superior to tenofovir disoproxil fumarate/emtricitabine 1.
- Both medications require consistent daily dosing for maximum effectiveness and regular HIV testing every 3 months, along with screening for other sexually transmitted infections.
- Medication cost and insurance coverage are also important practical considerations when choosing between Truvada and Descovy.
- It's worth noting that long-acting injectable cabotegravir is also recommended as PrEP for cisgender men and transgender women who have sex with men, with injections provided at 8-week intervals 1.
From the Research
Efficacy of Truvada versus Descovy for PrEP
- The efficacy of Truvada (emtricitabine/tenofovir disoproxil fumarate) and Descovy (emtricitabine/tenofovir alafenamide) for Pre-Exposure Prophylaxis (PrEP) has been compared in several studies 2, 3, 4.
- Truvada has been shown to be effective in reducing the risk of HIV-1 infection in high-risk adults, with efficacy rates ranging from 44% to 75% in different studies 2.
- Descovy has been shown to be non-inferior to Truvada in terms of efficacy for HIV prevention, with a similar incidence of HIV-1 infection per 100 person-years 3, 4.
- A study published in 2020 found that Descovy had a lower incidence of HIV-1 infection compared to Truvada, with 0.16 infections per 100 person-years versus 0.34 infections per 100 person-years, respectively 3.
- Another study published in 2021 found that Descovy maintained its non-inferiority to Truvada for HIV prevention at 96 weeks of follow-up, with an incidence of HIV-1 infection per 100 person-years of 0.16 versus 0.30, respectively 4.
Safety and Tolerability
- Both Truvada and Descovy have been shown to be well-tolerated, with a low number of participants reporting adverse events that led to discontinuation of the study drug 3, 4.
- Descovy has been shown to have more favorable effects on bone mineral density and renal biomarkers compared to Truvada 3, 4.
- A study published in 2021 found that participants who switched from Truvada to Descovy reported improved safety as a reason for switching, although the scientific consensus supports the safety of both regimens 5.
Patient Preferences and Adherence
- A study published in 2021 found that over half of participants who switched from Truvada to Descovy reported that their doctor recommended switching, while 32% reported that perceived improved safety of Descovy motivated their decision to change their prescription 5.
- Another study published in 2017 found that a patient who chewed Truvada tablets instead of swallowing them whole maintained protective drug levels as measured by a novel urine tenofovir assay 6.