Indications for Descovy (Tenofovir Alafenamide)
Descovy (tenofovir alafenamide/TAF) is indicated for the treatment of chronic hepatitis B virus infection in adults with compensated liver disease and for HIV treatment as part of combination antiretroviral therapy.
Indications for Chronic Hepatitis B
Tenofovir alafenamide is a first-line treatment option for chronic hepatitis B virus (HBV) infection with the following specific indications:
- Adults with chronic HBV infection and compensated liver disease 1
- Patients with HBeAg-positive or HBeAg-negative chronic hepatitis B 2
- Recommended as a nucleos(t)ide analogue with high genetic barrier to resistance 3
TAF has several advantages over older medications:
- Provides effective and sustained viral suppression 4
- No documented resistance development through 8 years of treatment 5
- More favorable bone and renal safety profile compared to tenofovir disoproxil fumarate (TDF) 2
Indications for HIV Infection
For HIV treatment, tenofovir alafenamide is indicated:
- As part of combination antiretroviral therapy for HIV-infected adults 3
- Specifically in HIV/HBV co-infection, where it treats both infections simultaneously 3
- As a preferred component in patients with renal impairment (creatinine clearance >30 mL/min) 3
- As a preferred component in patients with or at risk for bone disease 3
Dosage and Administration
- For chronic HBV: 25 mg once daily 1
- For HIV: As part of fixed-dose combinations (dosage varies by formulation)
- Safe in patients with mild hepatic impairment 1
- Can be used in patients with creatinine clearance above 30 mL/min 3
Advantages Over Older Formulations
TAF demonstrates several clinical advantages over tenofovir disoproxil fumarate (TDF):
- Improved renal safety: Significantly smaller median change in estimated glomerular filtration rate compared to TDF (-1.2 vs. -4.8 mg/dl) 4
- Better bone safety: Significantly smaller decreases in bone mineral density in the hip (-0.33% vs. -2.51%) and lumbar spine (-0.75% vs. -2.57%) compared to TDF 4
- Maintained efficacy: Non-inferior to TDF in viral suppression through 8 years of treatment 5
- Higher ALT normalization rates: Significantly higher rates of ALT normalization compared to TDF 2
Special Populations
- Renal impairment: TAF is preferred over TDF in patients with or at risk for kidney disease 3
- Bone disease: TAF is recommended over TDF in patients with osteopenia or osteoporosis 3
- HIV/HBV co-infection: TAF is recommended as part of an effective HIV regimen 3
- Hepatitis B reactivation: TAF is recommended for treatment of HBV reactivation due to its high potency and high barrier to resistance 3
Monitoring Recommendations
When using TAF, monitor:
- HBV DNA levels every 3-6 months
- Liver function tests
- Renal function
- Bone mineral density in patients at risk
Contraindications and Cautions
- Not recommended in patients with creatinine clearance below 15 mL/min 1
- Not currently recommended in patients with moderate or severe hepatic impairment (Child-Pugh class B or C) 1
- Should not be used as monotherapy for HIV infection
TAF represents an important advancement in the treatment of both chronic HBV and HIV infections, offering similar efficacy to older formulations with improved safety profiles, particularly regarding renal and bone health.