Descovy vs. Truvada: What's the Difference?

Descovy (emtricitabine/tenofovir alafenamide) and Truvada (emtricitabine/tenofovir disoproxil fumarate) are orally administered (taken by mouth) prescription medications used to treat or prevent HIV-1 infection, the most common type of the human immunodeficiency virus (HIV).

As antiretroviral therapy (ART) treatment options, Descovy and Truvada, contain active ingredients classified as HIV nucleoside analog reverse transcriptase inhibitors (NRTIs). These medications prevent the virus from replicating.

Approximately 1.2 million people in the United States have HIV. However, about 13% of these individuals (156,000 people) do not know they have it.

There is no cure for HIV, but many treatments can help people live long and healthy lives. Descovy and Truvada are two drugs that can increase the quality of life following an HIV diagnosis.

This article will provide an in-depth comparison of Descovy and Truvada, examining their specific active ingredients, respective uses, dosing guidelines, potential side effects, and more.

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Understanding HIV

Taking ART as prescribed can help individuals reach (and maintain) an undetectable viral load. This means that the level of HIV in the blood is so low that it isn't seen on a lab test.

If HIV is not treated, it can lead to AIDS (acquired immunodeficiency syndrome). People with HIV are more likely to get certain infections or conditions, such as:

Hepatitis B and hepatitis C: Liver infections that can be spread through injection drug use or sex
Opportunistic infections (OIs): Infections that are more likely to occur in people with weakened immune systems (when a person with HIV gets certain OIs or cancers, they are diagnosed with AIDS)

ART helps people who already have HIV in the following ways:

To prevent people at risk for HIV from getting HIV. This is called pre-exposure prophylaxis (PrEP). Two drugs in pill form are used for PrEP: Descovy and Truvada. There is also a shot called Apretude (cabotegravir) that can prevent HIV-1 infection.
To prevent the virus from "taking hold" when taken within 72 hours after a possible HIV exposure. This is called post-exposure prophylaxis (PEP).

Descovy or Truvada can be used in people with HIV (in combination with other medicines) and for PrEP. These medicines are not used as PEP.

What Is Descovy?

Descovy is a type of ART that blocks enzymes the HIV needs to multiply. Descovy contains two active NRTIs: emtricitabine (FTC) and tenofovir alafenamide (TAF). Descovy is only a brand-name drug (no generic is available).

It is approved by the Food and Drug Administration (FDA) for the following:

To treat HIV-1 infection in adults and children who weigh at least 30.8 pounds (in combination with other antiretroviral medicine, but not alone)
Along with practicing safe sex with condoms to prevent HIV-1 infection in adults and adolescents who weigh at least 77 pounds and who are at risk of getting HIV through sex (this does not include people at risk from receptive vaginal sex or penile-vaginal sex, as Descovy has not been studied in this group)

Descovy also is not FDA-approved to prevent HIV-1 due to injection drug use.

Finally, Descovy does not prevent or treat other sexually transmitted infections (STIs), such as syphilis, chlamydia, or gonorrhea. It also does not prevent pregnancy.

What Is Truvada?

Like Descovy, Truvada is a type of ART that blocks enzymes that the HIV needs to multiply. Truvada contains two active NRTIs: emtricitabine (FTC) and tenofovir disoproxil fumarate (TDF).

Truvada is an orally administered medication available in brand-name and generic forms.

It is FDA-approved for the following:

To treat HIV-1 infection in adults and children who weigh at least 37 pounds (in combination with other antiretroviral medicine, but not alone)
To prevent HIV-1 infection in adults and adolescents who weigh at least 77 pounds and who are at risk of getting HIV through sex (along with practicing safer sex with condoms) or from injection drug use

Like Descovy, Truvada does not protect against other STIs or pregnancy.

Tenofovir in Descovy and Truvada

Descovy and Truvada both contain FTC. However, the other active ingredient in Descovy and Truvada is slightly different.

Descovy contains TAF, while Truvada contains TDF (tenofovir with a slightly different chemical structure). Clinical trials show that both drugs are similarly effective.

However, Descovy was safer for the kidneys and healthier for the bones (as measured by bone mineral density (BMD), a measure of calcium and minerals in the bone).

Dosing Comparison

The following section describes how each drug is supplied, the required blood work, and dosages.

People with kidney problems should discuss dosing and appropriateness with their healthcare provider before beginning treatment with Descovy or Truvada.

Depending on the extent of kidney problems, a lower dose may be needed, or the drug may not be safe.

Descovy

Descovy tablets are available in the following dosages in milligrams (mg) of FTC to mg of TAF (FTC/TAF), meaning the comparative amount of mg of one active ingredient versus the other:

120 mg/15 mg
200 mg/25 mg

Your healthcare provider will order lab work to check for:

Hepatitis B infection (before you take Descovy)
Kidney function (before taking Descovy and regularly while taking Descovy)
HIV-1 infection (before starting Descovy, at least every three months, and if you are diagnosed with any other STIs)

Descovy may be taken with or without food. The dosages for the treatment of HIV-1 infection in milligrams of FTC to TAF are:

Adults and children weighing at least 77 pounds: 200 mg/25 mg once daily
Children weighing 55 pounds and less than 77 pounds: 200 mg/25 mg once daily
Children weighing 30.8 to 55 pounds: 120 mg/15 mg once daily

The dosage for PrEP in people who weigh at least 77 pounds is 200 mg/25 mg once daily.

Truvada

Truvada tablets are available in the following dosages in milligrams of FTC to milligrams of TDF (FTC/TDF):

100 mg/150 mg
133 mg/200 mg
167 mg/250 mg
200 mg/300 mg

Your healthcare provider will order lab work to check for:

Hepatitis B infection (before you take Truvada)
Kidney function (before taking Truvada and regularly while taking Truvada)
HIV-1 infection (before starting Truvada, at least every three months, and if you are diagnosed with any other STIs)

Truvada may be taken with or without food. The dosages for the treatment of HIV-1 infection in milligrams of FTC to TDF are:

Adults and children weighing at least 77 pounds: 200 mg/300 mg once daily
Children weighing at least 37.4 pounds: 100 mg/150 mg, 133 mg/200 mg, or 167 mg/250 mg once daily

The dosage for PrEP in people who weigh at least 77 pounds: is 200 mg/300 mg once daily.

Guidance on Safe Consumption

Regardless of which medication you take, there are some tips to keep in mind:

These medications do not prevent other STIs, so it is important to practice safer sex with latex or polyurethane condoms.

To continue to take Descovy or Truvada for PrEP, you must remain HIV-1 negative. Although one of these medications may be prescribed for PrEP, Descovy or Truvada alone is insufficient to treat HIV-1 infection. If you become HIV-1 positive, you will need additional medication.

If you have HIV-1 infection and take only Descovy or Truvada, this is not an appropriate treatment regimen and could make your infection harder to treat over time. Always know your HIV-1 status as well as the status of your partner.

Test for HIV-1 at least every three months or when your healthcare provider recommends. You should also get tested for other sexually transmitted infections.

Other infections like syphilis, gonorrhea, or chlamydia make it easier for you to be infected with HIV-1.

If you have a partner with HIV-1, ask if they are taking HIV-1 medication and if they have an undetectable viral load.

Notify your healthcare provider immediately if you are exposed to HIV-1. Do not miss any doses of your medication because missing doses increase the risk of getting HIV-1 infection.

Side Effects & Safety

Black Box Warning

Descovy and Truvada have a black box warning, the most severe warning issued by the FDA.

The warning states:

Severe worsening of hepatitis B has been reported in people who have hepatitis B and have stopped taking medications that contain the ingredients in Descovy or Truvada. People who have hepatitis B will have their liver function closely monitored after stopping one of these medications.
Individuals who take Descovy or Truvada for HIV-1 PrEP must be confirmed to be HIV-negative just before starting treatment with Descovy or Truvada and at least every three months while taking the medication. People with symptoms of HIV-1 infection should be tested. Descovy or Truvada alone is not an appropriate treatment for HIV-1 as they must be combined with other antiretroviral medicines to treat HIV-1 infection.

Common Side Effects

Common side effects of Descovy and Truvada are:

Severe Side Effects

More rare, severe side effects, such as kidney or liver problems can occur, too, as a result of using Descovy or Truvada.

Before taking Descovy or Truvada, talk to your healthcare provider about what side effects to expect and what to do if you experience them.

Potential for Interaction

Tell your healthcare provider about all your medicines, including prescription, over-the-counter (OTC) drugs, and vitamins or supplements.

While taking Descovy or Truvada, do not start any new medications without approval from your healthcare provider.

Drug interactions of both Descovy and Truvada include:

While alcohol does not chemically interact with Descovy or Truvada, consult your healthcare provider if you drink alcohol. It is best to avoid alcohol while taking Descovy or Truvada because:

Alcohol may affect the immune system, which may make the medicines less effective.
Alcohol can be associated with risky behavior.

Summary

HIV is spread through certain body fluids of an individual with HIV. It's most commonly spread through sharing injection drug needles or other equipment or during unprotected sex.

Descovy and Truvada are two prescription medications used to treat (in combination with other medicines) or prevent HIV-1 infection.

Truvada contains FTC and TDF. Descovy contains FTC and TAF, which may be safer for kidney and bone health.

However, Descovy is not FDA-approved for preventing HIV-1 from injection drug use or receptive vaginal sex. Neither of these medications treats or prevents other STIs or pregnancy.

If diagnosed with HIV, work closely with your healthcare provider to formulate an ideal, personalized treatment plan possible moving forward.

Frequently Asked Questions

Store Descovy or Truvada at room temperature (between 68 and 77 degrees F), away from direct light, heat, and moisture. Do not store it in the bathroom.
Keep the bottle tightly closed when not in use. Keep the medication out of reach of children and pets.
Either medication can be taken with or without food.
The prescribing information does not specify an ideal time of day to take Descovy or Truvada. Instead, it's important to remember that you should take this medicine once daily at a time that you can remember. Do not skip doses.
For example, if you go to bed around 11 p.m., you can set a reminder on your phone to take your daily dose every day at 11 p.m.
The best time is when you will remember to take your medication consistently daily.

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