Truvada (Emtricitabine/Tenofovir Disoproxil Fumarate) Dosage and Use for HIV Prevention and Treatment
For HIV prevention (PrEP), Truvada is recommended as one tablet (containing emtricitabine 200 mg/tenofovir disoproxil fumarate 300 mg) taken orally once daily, with regular monitoring for HIV, STIs, renal function, and pregnancy in women. 1, 2
Recommended Dosage
For HIV Prevention (PrEP):
- One tablet of Truvada (emtricitabine 200 mg/tenofovir disoproxil fumarate 300 mg) taken orally once daily without regard to food 1, 3
- For MSM, a double dose (2 tablets) on the first day followed by once daily dosing is recommended to achieve maximal protection more quickly 1
- MSM may also use the 2-1-1 (on-demand) dosing schedule: double dose 2-24 hours before sex, followed by single doses 24 and 48 hours after the first dose 1
- For women and other populations, daily dosing is critical as tenofovir concentrates at lower levels in vaginal tissue than rectal tissue 2
For HIV Treatment:
- One tablet (emtricitabine 200 mg/tenofovir disoproxil fumarate 300 mg) taken orally once daily as part of a combination antiretroviral regimen 3
- For pediatric patients weighing at least 35 kg: one 300 mg tablet daily 3
- For pediatric patients 2 years and older weighing 17-35 kg: weight-based dosing (150-250 mg tablets) 3
Pre-Initiation Testing
Before starting Truvada, the following tests should be performed 1, 2, 3:
- HIV antibody/antigen test to confirm HIV-negative status
- Hepatitis B surface antigen testing
- Serum creatinine and estimated creatinine clearance
- Urine glucose and protein
- STI screening (gonorrhea, chlamydia, syphilis)
- Pregnancy test for women of childbearing potential
Monitoring During Treatment
For PrEP:
- HIV testing every 2-3 months 1, 2
- Pregnancy testing for women at each visit 1
- Creatinine clearance at 3 months after initiation, then every 6 months 1
- STI screening every 6 months, even if asymptomatic 1, 2
- Adherence assessment and support at each visit 1
Special Considerations
Renal Impairment:
- No dosage adjustment for mild renal impairment (CrCl ≥50 mL/min) 3
- For moderate impairment (CrCl 30-49 mL/min): 300 mg every 48 hours 3
- For severe impairment (CrCl 10-29 mL/min): 300 mg every 72-96 hours 3
- For hemodialysis patients: 300 mg every 7 days or after approximately 12 hours of dialysis 3
Pregnancy and Breastfeeding:
- Daily Truvada is recommended for pregnant women at risk of HIV 1
- Women should be informed that safety data for infants exposed during pregnancy is incomplete but no harm has been reported 1
- Truvada is not recommended during breastfeeding for PrEP purposes 1
Alternative Options
- For MSM with renal impairment (CrCl 30-60 mL/min), history of osteopenia/osteoporosis, or high risk for these complications, Descovy (emtricitabine/tenofovir alafenamide) may be considered 1, 4
- Descovy is NOT currently recommended for cisgender women or for prevention of HIV infection from receptive vaginal sex 4
- Descovy is also not recommended for on-demand or event-driven PrEP 4
Important Cautions
- Truvada alone should not be used in patients with HIV-1 infection 3
- Severe acute exacerbations of hepatitis B have been reported in patients with HBV who discontinue Truvada 3
- PrEP should be delivered as part of a comprehensive prevention package including risk reduction counseling and condoms 1
- Prescriptions should not exceed 90 days without interval HIV testing 2