Truvada as Pre-Exposure Prophylaxis (PrEP)
Yes, Truvada (emtricitabine and tenofovir disoproxil fumarate) is definitively considered a form of pre-exposure prophylaxis (PrEP) for HIV prevention and is the original FDA-approved medication for this purpose. 1, 2
What is Truvada?
- Truvada is a fixed-dose combination tablet containing 200 mg of emtricitabine (FTC) and 300 mg of tenofovir disoproxil fumarate (TDF) 1
- It was the first medication approved for use as PrEP for HIV prevention 2
- Truvada is marketed by Gilead Sciences and is now also available as a generic medication 1
Truvada's Role in PrEP
- Truvada is recommended as a daily oral PrEP regimen for all populations at risk of HIV infection through sexual exposure or injection drug use 1, 3
- It has demonstrated high efficacy in preventing HIV acquisition when taken as prescribed 1, 4
- For MSM, Truvada can be used either as daily PrEP or as on-demand (2-1-1) dosing 1, 4
- For women and people who inject drugs, only daily dosing of Truvada is recommended 5, 4
Dosing Considerations
- Daily dosing: One tablet of Truvada taken once daily is the standard regimen for all populations 1, 3
- On-demand (2-1-1) dosing (for MSM only):
- Daily dosing is especially important for women as tenofovir concentrates at 10-fold lower levels in vaginal tissue compared to rectal tissue 5, 6
Effectiveness
- Truvada has been shown to reduce HIV acquisition by up to 44% in the general population and by up to 92% when adherence is high 1
- Even against FTC-resistant HIV strains, Truvada maintains prophylactic efficacy due to the presence of tenofovir 7
- Protection begins after approximately 7 days of daily use for vaginal exposure and potentially sooner for rectal exposure 1, 3
Monitoring Requirements
- HIV testing must be performed before initiating Truvada as PrEP 1, 4
- Regular follow-up visits (typically every 3 months) are required for:
- PrEP prescriptions should not exceed 90 days without interval HIV testing 1, 4
Important Considerations
- Truvada does not protect against other sexually transmitted infections 5, 4
- Adherence is critical for effectiveness 2
- Truvada is safe for use during pregnancy and breastfeeding 3
- Caution is needed in patients with renal impairment (creatinine clearance <60 mL/min) 4
- For patients with renal concerns or bone health issues, tenofovir alafenamide/emtricitabine (Descovy) may be an alternative for MSM, but not for those at risk through vaginal sex 4, 8
Truvada remains a cornerstone of HIV prevention strategies worldwide, with extensive evidence supporting its safety and efficacy when used as directed.