What is the recommended dosing of Descovy (emtricitabine and tenofovir alafenamide) for HIV post-exposure prophylaxis (PEP) after needle exposure?

Descovy Dosing for HIV Post-Exposure Prophylaxis (PEP) After Needle Exposure

For HIV post-exposure prophylaxis (PEP) after needle exposure, the recommended regimen includes Descovy (emtricitabine 200 mg/tenofovir alafenamide 25 mg) taken once daily as part of a complete 28-day regimen that should also include an integrase strand transfer inhibitor. 1

Recommended PEP Regimen Components

• The preferred regimens for adults and adolescents requiring PEP include either:

  • Bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) as a single tablet regimen 1
  • Dolutegravir plus emtricitabine/tenofovir alafenamide (Descovy) 1

• The complete PEP course should be 28 days in duration 1

• PEP should be initiated as soon as possible after exposure, ideally within 72 hours 1

Specific Dosing Instructions

• Descovy (emtricitabine/tenofovir alafenamide) dosage for PEP is one tablet (200 mg/25 mg) taken orally once daily 1, 2

• When using Descovy as part of a PEP regimen, it should be taken with or without food 1

• Unlike PrEP regimens, there is no loading dose recommendation for Descovy when used for PEP 2

Monitoring and Follow-up

• Before initiating PEP, perform:

  • HIV testing (rapid or laboratory-based antigen/antibody combination test) 1
  • Clinical assessment for medical comorbidities, current medications, and allergies 1
  • Baseline laboratory tests including serum creatinine 1

• Follow-up HIV testing should be performed:

  • 4-6 weeks after exposure (may be deferred if PEP was started within 24 hours and no doses were missed) 1
  • 12 weeks after exposure (final HIV test) 1

Advantages of Tenofovir Alafenamide-Based Regimens

• Descovy (FTC/TAF) shows improved renal and bone safety profiles compared to regimens containing tenofovir disoproxil fumarate 3, 4

• Studies show that TAF-based regimens have higher completion rates and fewer side effects compared to historical PEP regimens 5

• TAF-containing regimens demonstrate favorable pharmacokinetics with higher intracellular concentrations of the active drug 6

Special Considerations

• For individuals with renal impairment, Descovy is preferred over TDF-containing regimens, particularly for those with creatinine clearance between 30-60 mL/min 7, 4

• PEP should be stopped if at any point during the course the source is found to not have HIV 1

• For individuals with anticipated ongoing HIV exposure risk, consider transition from PEP to PrEP after completion of the 28-day PEP course 1

Common Side Effects and Management

• The most common side effects of Descovy-based PEP regimens include:

  • Fatigue (reported in 9.6% of patients) 5
  • Nausea or vomiting (reported in 15.4% of patients) 5
  • Diarrhea/loose stools (reported in 7.7% of patients) 5

• These side effects are generally self-limited and rarely lead to discontinuation of the regimen 5