From the Guidelines
Yes, people can be on Descovy for PrEP long-term, as it is FDA-approved for daily use as pre-exposure prophylaxis to prevent HIV infection, and can be taken continuously for years with regular medical monitoring. Descovy (emtricitabine 200 mg/tenofovir alafenamide 25 mg) is recommended for men who have sex with men (MSM) with or at risk for kidney dysfunction, osteopenia, or osteoporosis, as it has a better safety profile compared to tenofovir disoproxil fumarate/emtricitabine 1. Users should take one tablet daily at approximately the same time each day, with or without food. While on Descovy for PrEP, patients need:
- HIV testing every 3 months
- Kidney function monitoring
- STI screening
- Pregnancy testing if applicable Long-term use is considered safe for most eligible individuals, as Descovy has less impact on bone density and kidney function than older PrEP medications like Truvada 1. However, Descovy is only approved for cisgender men and transgender women; cisgender women should use Truvada instead. Side effects are typically mild and often resolve after the first few weeks, including headache, nausea, and stomach discomfort. Descovy provides approximately 99% protection against HIV when taken consistently, but does not protect against other STIs, so condom use is still recommended. It's worth noting that injectable cabotegravir every 8 weeks is also recommended as PrEP for cisgender men and transgender women who have sex with men, but this is a different treatment option 1.
From the Research
Long-term Descovy for PrEP
- The studies 2, 3 demonstrate the efficacy and safety of emtricitabine and tenofovir alafenamide (Descovy) for HIV pre-exposure prophylaxis (PrEP) in the long term.
- The DISCOVER trial 2 showed that Descovy was non-inferior to emtricitabine and tenofovir disoproxil fumarate for HIV prevention at 48 weeks, with a low number of adverse events leading to discontinuation.
- The 96-week results from the same trial 3 confirmed the non-inferiority of Descovy, with eight HIV infections in the Descovy group (0.16 infections per 100 person-years) and 15 in the emtricitabine and tenofovir disoproxil fumarate group (0.30 infections per 100 person-years).
- A systematic review and meta-analysis 4 found that PrEP, including Descovy, is safe and effective in preventing HIV in men who have sex with men, serodiscordant couples, and people who inject drugs.
Safety and Efficacy
- The studies 2, 3 reported that Descovy had a favorable safety profile, with improved bone mineral density and renal biomarkers compared to emtricitabine and tenofovir disoproxil fumarate.
- The incidence of HIV infection was low in both groups, with Descovy showing non-inferior efficacy to emtricitabine and tenofovir disoproxil fumarate at 96 weeks 3.
- Adherence to Descovy was high, with approximately 78-82% of participants reporting taking the study medication more than 95% of the time 3.
Population-Specific Findings
- The systematic review and meta-analysis 4 found that PrEP, including Descovy, is effective in preventing HIV in men who have sex with men, serodiscordant couples, and people who inject drugs, but not in heterosexuals.
- The DISCOVER trial 2, 3 specifically studied adult cisgender men and transgender women who have sex with men, and found that Descovy was safe and effective in this population.