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

Truvada Dosage 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

Standard Dosing Regimen

Truvada for PrEP consists of a fixed-dose combination tablet containing:

• Emtricitabine (FTC) 200 mg
• Tenofovir disoproxil fumarate (TDF) 300 mg

This medication should be taken:

• Once daily
• With or without food
• Consistently at approximately the same time each day to maintain adequate drug levels

Dosing Options

Daily Dosing (Standard Approach)

• Recommended for all populations eligible for PrEP
• Provides continuous protection when taken consistently
• Supported by high-quality evidence across multiple studies 1, 2

Event-Driven PrEP (Alternative for MSM Only)

For men who have sex with men (MSM), an alternative "on-demand" or 2-1-1 dosing regimen may be considered:

• 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

Important: Event-driven PrEP is not recommended for women, transgender individuals, or people who inject drugs, as evidence supports only daily dosing for these populations.

Special Populations and Considerations

Renal Impairment

For patients with reduced kidney function, dosage adjustments are necessary:

• Creatinine clearance 30-49 mL/min: Take one tablet every 48 hours
• Creatinine clearance 10-29 mL/min: Take one tablet every 72-96 hours
• Hemodialysis: Take one tablet every 7 days or after approximately 12 hours of dialysis 3

Truvada is not recommended for patients with creatinine clearance <30 mL/min 1

Hepatitis B Infection

• Patients should be screened for hepatitis B before starting PrEP
• Discontinuation of Truvada in patients with chronic hepatitis B can cause severe acute exacerbations of hepatitis 3
• Hepatic function should be monitored closely if Truvada is discontinued 3

Monitoring and Follow-up

Regular monitoring is essential while on PrEP:

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

Efficacy and Adherence

The effectiveness of Truvada for PrEP is highly dependent on adherence:

• Studies show efficacy rates of 44-75% overall, with higher rates (>90%) when adherence is excellent 2
• Daily dosing has demonstrated protection in MSM, heterosexual men and women, and people who inject drugs 2

Common Pitfalls to Avoid

1. Starting PrEP without confirming HIV-negative status - can lead to drug resistance
2. Poor adherence - significantly reduces effectiveness
3. Inadequate monitoring - particularly of renal function
4. Using event-driven dosing in non-MSM populations - not supported by evidence
5. Discontinuing PrEP without proper follow-up - especially in those with hepatitis B

Remember that Truvada for PrEP is just one component of a comprehensive HIV prevention strategy that should include regular testing for HIV and other STIs, condom use, and risk reduction counseling.