What are the alternatives if Truvada (emtricitabine/tenofovir disoproxil fumarate) is causing hives?

Alternatives to Truvada for Patients Experiencing Hives

For patients experiencing hives from Truvada (emtricitabine/tenofovir disoproxil fumarate), switching to Descovy (emtricitabine/tenofovir alafenamide) is the recommended alternative for HIV prevention.1

Alternative Regimens for HIV Prevention

Preferred Alternative Options

• Descovy (emtricitabine/tenofovir alafenamide) is the most appropriate alternative for patients experiencing hives from Truvada, as it maintains similar efficacy while potentially reducing adverse reactions 1
• For post-exposure prophylaxis (PEP), Descovy can be combined with an integrase strand transfer inhibitor such as bictegravir or dolutegravir as part of a complete regimen 2
• The standard dosing for Descovy is one tablet (200 mg emtricitabine/25 mg tenofovir alafenamide) taken orally once daily with or without food 1

Secondary Alternative Options

• Bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) as a single-tablet regimen is another preferred option for adults requiring HIV prevention 2
• For patients who cannot tolerate either tenofovir formulation, regimens containing dolutegravir plus lamivudine may be considered 2
• In cases where integrase inhibitors are not available, darunavir/ritonavir plus emtricitabine or darunavir/ritonavir plus lamivudine can be used as alternative regimens 2

Considerations for Special Populations

HIV/HBV Co-infection Considerations

• For patients with HIV/HBV co-infection who cannot tolerate Truvada, Descovy remains important as both emtricitabine and tenofovir have activity against hepatitis B virus 2
• If tenofovir cannot be used at all, entecavir might be considered as part of an alternative HIV regimen for managing HBV co-infection 2
• Lamivudine alone should be avoided as the only anti-HBV active agent due to high incidence of resistance 2

Pregnancy Considerations

• The CDC notes that safety data for infants exposed to tenofovir alafenamide during pregnancy are still being collected, though no harm has been reported with tenofovir disoproxil fumarate 2
• For pregnant women experiencing hives with Truvada, consultation with both HIV and obstetric specialists is recommended to select the most appropriate alternative 2

Monitoring After Switching Medications

• HIV testing should be performed before initiating any alternative regimen 1
• Follow-up HIV testing is recommended at 4-6 weeks and 12 weeks after exposure 1
• Monitor for any new adverse reactions after switching to the alternative medication 2
• For patients with renal concerns, regular monitoring of renal function is particularly important when using tenofovir-containing regimens 3

Clinical Pearls and Pitfalls

• Hypersensitivity reactions can occur with any medication component - when switching from Truvada to an alternative, it's important to identify which specific component caused the reaction (emtricitabine or tenofovir disoproxil fumarate) 3
• Do not discontinue PrEP or PEP without replacement - maintain continuous protection by immediately switching to an alternative regimen 2
• Consider drug interactions when selecting alternative regimens, particularly with medications that may affect renal function 1
• Adherence remains critical regardless of which regimen is selected - suboptimal adherence (≤95%) significantly reduces effectiveness of HIV prevention 4

Remember that while Descovy is the most appropriate alternative for most patients experiencing hives from Truvada, the final selection should prioritize maintaining effective HIV prevention while avoiding the adverse reaction that prompted the switch.