From the Research
Descovy (emtricitabine and tenofovir alafenamide) should be withheld when ALT or AST elevations exceed 5 times the upper limit of normal (ULN), especially if accompanied by symptoms of hepatitis or other evidence of liver dysfunction, as supported by the most recent and highest quality study 1.
Key Considerations
- For patients with pre-existing liver disease, the threshold for concern may be lower, with close monitoring recommended when levels reach 3-5 times ULN.
- During treatment, regular liver function monitoring is essential, particularly in patients with underlying hepatitis B or C, alcohol use disorder, or those taking other potentially hepatotoxic medications.
- If Descovy is discontinued due to liver enzyme elevations, these levels should be monitored closely until they normalize.
Rationale
The recommendation to withhold Descovy at these levels stems from the medication's metabolism in the liver and the potential for drug-induced liver injury, though severe hepatotoxicity is relatively uncommon with this medication compared to some other antiretrovirals, as noted in studies such as 2 and 3.
Alternative Options
Alternative antiretroviral therapy options should be discussed with an HIV specialist if Descovy must be discontinued, considering the patient's overall health status and the potential risks and benefits of different treatment regimens, as suggested by research including 4 and 1.
Monitoring and Management
Close monitoring of liver function and adjustment of the treatment plan as needed are crucial to minimizing the risk of liver injury and ensuring the best possible outcomes for patients taking Descovy, as emphasized in studies like 5 and 1.