What is Truvada (emtricitabine and tenofovir disoproxil fumarate) used for?

Truvada (Emtricitabine and Tenofovir Disoproxil Fumarate) Uses

Truvada (emtricitabine 200 mg and tenofovir disoproxil fumarate 300 mg) is primarily used for HIV pre-exposure prophylaxis (PrEP) in high-risk individuals and as part of combination antiretroviral therapy for HIV treatment. 1

Primary Uses

1. HIV Pre-Exposure Prophylaxis (PrEP)

• High-risk populations who benefit from PrEP:

  • Men who have sex with men (MSM) with risk factors 1, 2
  • Heterosexually active adults at very high risk for HIV acquisition 1
  • Transgender women who have sex with men 2
  • People who inject drugs 2
  • Individuals with partners known to be HIV-positive 1

• Dosing regimens for PrEP:

  • Standard daily dosing: One tablet (TDF 300 mg/FTC 200 mg) daily 1, 2
  • For MSM only:
    • Option for 2-1-1 (on-demand) dosing: double dose 2-24 hours before sex, followed by single doses at 24 and 48 hours after first dose 1, 2
    • Initial dosing can include 2 tablets on first day for faster protection 1, 2
  • Post-exposure continuation:
    • MSM: Continue for 2 days after last exposure 1, 2
    • Others: Continue for 7 days after last exposure 1, 2

2. HIV Treatment

• Used as part of combination antiretroviral therapy (ART) 1
• Often combined with a third agent from another antiretroviral class 1
• Particularly valuable in patients co-infected with HIV and hepatitis B virus (HBV) 1

Additional Benefits

• Hepatitis B treatment: Active against HBV, making it valuable for patients with HIV/HBV co-infection 1, 3
• Once-daily dosing: Long half-lives of both components allow for convenient once-daily administration 3
• Low drug interaction potential: Not metabolized by cytochrome P450 enzymes, reducing potential for many drug interactions 3

Monitoring Requirements

• Before starting:

  • HIV antibody/antigen test (negative result required) 1, 2
  • Renal function (creatinine clearance ≥60 mL/min) 1, 2
  • Hepatitis B screening 1, 2
  • STI screening 1, 2

• Follow-up monitoring:

  • HIV testing every 2-3 months 1, 2
  • Renal function every 3-6 months 1, 2
  • STI screening every 6 months 1, 2
  • Pregnancy testing for women at each visit 1

Important Considerations and Cautions

• Renal safety: Not recommended for patients with creatinine clearance <60 mL/min 1, 3
• Pregnancy: Safety data incomplete but no harm reported; can be used during pregnancy if benefits outweigh risks 1
• Breastfeeding: Not recommended during breastfeeding 1
• Drug resistance: Must confirm HIV-negative status before initiating to prevent development of resistance 1, 2
• Adherence: Critical for efficacy; poor adherence significantly reduces protection 2

Newer Alternatives

For patients with renal concerns, emtricitabine/tenofovir alafenamide (Descovy) may be considered for MSM and transgender women (not approved for those at risk through vaginal sex) 1, 4, 5. This formulation shows improved bone and renal safety profiles compared to Truvada 4, 5.