What is the recommended dose of Descovy (emtricitabine and tenofovir alafenamide) for Pre-Exposure Prophylaxis (PrEP)?

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Last updated: October 9, 2025 • View editorial policy

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Recommended Dose of Descovy for PrEP

For men who have sex with men (MSM) with or at risk for kidney dysfunction, osteopenia, or osteoporosis, the recommended dose of Descovy (emtricitabine 200 mg/tenofovir alafenamide 25 mg) for PrEP is one tablet taken orally once daily. 1

Dosing Recommendations by Population

  • Descovy (emtricitabine/tenofovir alafenamide) is specifically indicated for MSM and transgender women who have sex with men who have or are at risk for kidney dysfunction, osteopenia, or osteoporosis 1
  • The standard dosage is one tablet (emtricitabine 200 mg/tenofovir alafenamide 25 mg) taken orally once daily 1
  • Unlike Truvada (emtricitabine/tenofovir disoproxil fumarate), there is no recommendation for a double loading dose on the first day when starting Descovy 1
  • Descovy should be taken daily for continued protection, not on an event-driven or "2-1-1" dosing schedule 1

Important Limitations of Descovy for PrEP

  • Descovy is NOT currently recommended for:
    • Cisgender women 1, 2, 3
    • Prevention of HIV-1 infection from receptive vaginal sex 1
    • On-demand or event-driven PrEP (the "2-1-1" dosing schedule) 1

Clinical Evidence for Descovy in PrEP

  • The DISCOVER trial demonstrated that Descovy was non-inferior to Truvada for HIV prevention in MSM and transgender women who have sex with men 4, 2
  • After 8,756 person-years of follow-up, HIV incidence was 0.16 infections per 100 person-years in the Descovy group versus 0.34 infections per 100 person-years in the Truvada group 4
  • Descovy showed improved bone mineral density and renal safety biomarkers compared to Truvada 4, 2
  • Long-term (96-week) data confirmed continued non-inferior efficacy with Descovy compared to Truvada 2

Monitoring Recommendations

  • Before initiating Descovy:

    • Combined HIV antibody and antigen testing (HIV RNA testing if clinical suspicion of acute HIV) 1
    • Serum creatinine level and estimated creatinine clearance 1
    • Hepatitis B surface antigen 1
    • Hepatitis C antibody testing 1
    • STI testing (gonorrhea, chlamydia, syphilis) 1

  • During Descovy PrEP:

    • HIV testing at 1 month and quarterly thereafter 1
    • Creatinine clearance at first quarterly visit and annually thereafter (more frequently for those at risk of kidney injury) 1
    • STI testing quarterly 1

Clinical Considerations and Caveats

  • Descovy is preferred over Truvada specifically for MSM with renal impairment (creatinine clearance between 30-60 mL/min) or bone health concerns 1, 5
  • Descovy has been associated with more weight gain compared to Truvada (median 1.7 kg vs 0.5 kg at 96 weeks) 2
  • Descovy should not be initiated in persons with suspected or confirmed HIV infection 1
  • PrEP effectiveness is highly dependent on adherence to daily dosing 4, 2

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

5
Guideline

Bone Health Considerations for PrEP Users

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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