Transitioning from Apretude (Cabotegravir) to Descovy (Emtricitabine/Tenofovir Alafenamide) for PrEP
When transitioning from injectable cabotegravir (Apretude) to oral Descovy (emtricitabine/tenofovir alafenamide) for PrEP, patients should begin taking daily Descovy at least 12 weeks after their last cabotegravir injection to ensure continuous HIV protection during the pharmacokinetic tail period of cabotegravir. 1
Transition Protocol
Timing of Transition
- Begin Descovy within 12 weeks after the last cabotegravir injection to maintain continuous HIV protection during the cabotegravir pharmacokinetic tail period 1
- For optimal protection, start Descovy before cabotegravir drug levels fall below protective thresholds 1
HIV Testing Requirements
- Perform HIV testing (ideally antigen/antibody combination test AND HIV RNA test) before initiating Descovy to confirm HIV-negative status 1
- This testing is crucial as delayed seroconversion can occur with prior cabotegravir use 1
Monitoring During Transition
- Schedule follow-up HIV testing at 4-6 weeks after starting Descovy 1
- Continue quarterly HIV testing after transition is complete 1
- Monitor renal function as Descovy requires creatinine clearance ≥30 mL/min 2
Special Considerations
Advantages of Descovy Over TDF-Based PrEP
- Descovy shows improved renal and bone safety profiles compared to TDF-based regimens 2
- Particularly beneficial for patients with or at risk for renal dysfunction, osteopenia, or osteoporosis 1
Population-Specific Guidance
- Descovy is FDA-approved for cisgender men and transgender women who have sex with men 2
- For cisgender women, additional counseling about daily adherence is essential as pharmacokinetic data differs from injectable cabotegravir 1
Adherence Support
- Provide adherence counseling during transition, emphasizing the importance of daily dosing with Descovy versus the every-8-week schedule of cabotegravir 3
- Consider providing medication reminders or adherence tools to support the transition to daily oral PrEP 1
Common Pitfalls to Avoid
- Inadequate HIV testing: Failure to perform comprehensive HIV testing (including RNA testing) before transition could miss early HIV infection 1
- Premature discontinuation of cabotegravir without overlap: Stopping cabotegravir without a plan for transition to Descovy may leave patients vulnerable to HIV acquisition 1
- Inadequate monitoring: Failing to monitor for potential side effects during the transition period 2, 4
- Insufficient adherence support: Not providing adequate counseling about the switch from injectable to daily oral medication 3
This transition protocol prioritizes continuous HIV protection while accounting for the pharmacokinetic properties of both medications to minimize the risk of HIV acquisition during the transition period.