What is the recommended dose of Truvada (emtricitabine and tenofovir disoproxil fumarate) for Pre-Exposure Prophylaxis (PrEP)?

Truvada Dosing for PrEP

The recommended standard dose of Truvada for HIV Pre-Exposure Prophylaxis (PrEP) is one tablet (containing emtricitabine 200 mg/tenofovir disoproxil fumarate 300 mg) taken orally once daily, regardless of food intake. 1, 2

Dosing Regimens Based on Risk Group

For All Populations at Risk:

• Standard daily dosing: One tablet of Truvada (TDF 300 mg/FTC 200 mg) daily 1, 2

For Men who have Sex with Men (MSM):

• Option 1 - Daily dosing with accelerated start:

  • First day: Double dose (2 tablets) to achieve faster protection
  • Thereafter: One tablet daily 1
  • Protection achieved within 24 hours of double dose 1
  • Continue for 2 days after last sexual exposure 1

• Option 2 - 2-1-1 (on-demand) dosing (for MSM only):

  • 2 tablets taken 2-24 hours before sexual activity
  • 1 tablet 24 hours after the first dose
  • 1 tablet 48 hours after the first dose 1, 2

For Other Risk Groups (heterosexual men and women, people who inject drugs):

• Daily dosing only (on-demand dosing not recommended)
• Protection achieved approximately 7 days after initiation
• Continue for 7 days after last risk exposure 1

Special Populations

Renal Impairment:

• Not recommended for patients with creatinine clearance <60 mL/min 2
• For MSM with creatinine clearance between 30-60 mL/min who have osteopenia/osteoporosis:
  • Consider tenofovir alafenamide/emtricitabine (TAF/FTC) instead 1, 2

Pregnancy and Breastfeeding:

• Daily Truvada is recommended for at-risk pregnant individuals 1
• Safety data for pregnancy is incomplete, but no harm has been reported 2

Required Testing Before Initiation

1. Combined HIV antibody and antigen testing (HIV RNA if acute infection suspected)
2. Serum creatinine level
3. Hepatitis B surface antigen
4. Hepatitis C antibody (if not known to be previously positive)
5. STI screening (gonorrhea and chlamydia at all potential exposure sites) 1, 2

Monitoring During PrEP

• At 1 month: HIV antibody/antigen test
• Quarterly:
  • HIV antibody/antigen test
  • STI screening
  • Pregnancy testing (if applicable)
• Every 6 months:
  • Estimated creatinine clearance 1, 2

Important Clinical Considerations

• Adherence is critical for PrEP efficacy - effectiveness exceeds 90% with good adherence 3
• The risk of developing resistance is low (<0.1%) when PrEP is properly prescribed 3
• Truvada does not protect against other STIs, so regular STI screening is essential 1, 2
• Efficacy varies by risk group and adherence levels, with demonstrated risk reductions of 44-75% in major clinical trials 4

Pitfalls to Avoid

• Starting PrEP without confirming HIV-negative status can lead to resistance development
• Inadequate renal monitoring in patients with or at risk for kidney dysfunction
• Using on-demand dosing in populations other than MSM, where this approach has not been validated
• Failing to continue PrEP for the appropriate duration after last exposure (2 days for MSM, 7 days for others) 1, 2