DESCOVY

emtricitabine/tenofovir alafenamide (FTC/TAF)

Descovy is the new PrEP pill that contains emtricitabine plus tenofovir alafenamide (TAF) instead of tenofovir disoproxil fumarate (TDF). F/TAF is able to deliver higher concentrations of tenofovir into cells, reaches protective levels more quickly, and maintains protective levels of drug in cells longer than F/TDF. For these reasons, it is possible that F/TAF may be more effective than F/TDF for people who miss doses.
In the DISCOVER study, which demonstrated that F/TAF was “non-inferior” to F/TDF for PrEP (but did not determine that it was “superior” to F/TDF, there is no evidence that Descovy is more effective in preventing HIV than Truvada.), there were more HIV infections among people taking F/TDF ( the old PrEP, 11 infections) than among people taking F/TAF ( the new PrEP, 6 infections; these numbers exclude people who had suspected acute HIV infections at baseline), however this difference was not statistically significant. Although there is some debate about whether F/TAF truly is “more effective” than F/TDF for PrEP, there is just no evidence that Descovy is more effective in preventing HIV than Truvada as of January 2021.

What is better about combining with TAF is that it does not cause the same level of kidney problems or lower bone density that TDF does. Both Descovy and Truvada are recommended as first-line therapies in the HIV treatment guidelines worldwide. Both are approved and recommended for hepatitis B treatment. 

Seven years after Truvada (F/TDF) was approved for HIV prevention as PrEP, we now have another PrEP medication option. On October 3, 2019, the U.S. Food and Drug Administration (FDA) approved the medication Descovy (F/TAF) as PrEP for people who are HIV-negative and at-risk for acquired HIV through sexual contact.

STANDARD DOSE

One tablet once daily, without regard to food. Tablet contains 200 mg emtricitabine and 25 mg tenofovir alafenamide.

For adults and children weighing at least 55 pounds (25 kg). Crushing or splitting tablets has not been studied and is not recommended; TAF is soluble in water, but has a bitter and burnt aromatic flavor profile.

If missed a dose, take a missed dose as soon as possible, unless it is closer to the time of your next dose then just take the next one. Do not double up on your next dose. Descovy should not be used if CrCl is less than 30 mL/min or if you are on dialysis. In children weighing less than 77 pounds, taking Descovy with a boosted HIV protease inhibitor medication is not recommended.

Descovy was approved for HIV prevention (pre-exposure prophylaxis, or PrEP) in October 2019.

Descovy is the new PrEP pill, in that it contains emtricitabine plus tenofovir alafenamide (TAF) instead of tenofovir disoproxil fumarate (TDF). What is better about combining with TAF is that it does not cause the same level of kidney problems or lower bone density that TDF does. Both Descovy and Truvada are recommended as first-line therapies in the HHS HIV treatment guidelines. Both are approved and recommended for hepatitis B. Descovy has not been approved for PrEP, however. It is important not to combine with other antivirals not prescribed by a doctor. Many new STRs already contain TAF. Drug interactions may occur, so tell your doctor about all the medications your take, including those sold over the counter.

If you are looking for the generic new PrEP, contact Pulse Clinic: info.bkk@pulse-clinic.com

How is Descovy different than Truvada?

Take home message

It is clear PrEP alternatives are evolving: In the next several years, patients may expect an array of additional options that include generic equivalents, injectables, implants and other options. You are free to chose what's best for your condition and your lifestyle. Contact our clinic now to discuss about your health and what prevention strategy suit you best. We are available all year long.

References

1. Hare B, Coll J, Ruane P, et al. The phase III Discover study: daily F/TAF or F/TDF for HIV preexposure prophylaxis. Conference on Retroviruses and Opportunistic Infections, 4-11 March 2019, Seattle, Washington. Abstract 104.
2. Humphries B, Xie F. Canada’s amendment to patented drug price regulation: A prescription for global drug cost control? JAMA. 2019;321(16):1565-1566.
3. Califf RM and Slavitt S. Lowering cost and increasing access to drugs without jeopardizing innovation. JAMA. 2019;321(16):1571-1573.
4. Hall AM, Hendry BM, Nitsch D, et al. Tenofovir-associated kidney toxicity in HIV-infected patients: a review of the evidence. American Journal of Kidney Diseases. 2011 May;57(5):773-80.
5. Amrhein V, Greenland S, McShane B. Scientists rise up against statistical significance. Nature. 2019 Mar;567(7748):305-307