Descovy

Overall, Descovy is well tolerated, but some people may experience nausea, headache, stomach pain, or changes in weight. New data associate INSTIs and TAF with potential weight gain; see “More information,” and go to positivelyaware.com/articles/weighty-concerns and positivelyaware.com/articles/fatty-tissues. Skin discoloration on palms and soles may also occur. May affect the bones and kidneys. In clinical trials, fewer bone and kidney issues were observed with the TAF formulation compared to the TDF formulation. Tell your provider about any pain in extremities, persistent or worsening bone pain and fractures, with or without muscular pain or weakness, as well as any concerning changes in urinary habits as these could be signs of bone or kidney problems.

Prior to initiation, people should be tested for hepatitis B virus (HBV) infection. Severe exacerbations of hepatitis B have been reported in people co-infected with hepatitis B who have discontinued Descovy (due to elimination of both emtricitabine and TAF, which also treat HBV). Monitor liver enzymes closely in people co-infected with hepatitis B and, if appropriate, initiation of anti-hepatitis B therapy may be warranted upon Descovy discontinuation. Call your health care provider right away if you develop any of the following signs or symptoms of hepatitis: yellowing of the skin or whites of the eyes; dark or tea-colored urine; pale-colored bowel movements; nausea or vomiting; loss of appetite; or pain, aching, or tenderness on the right side below the ribs.

Do not take with Cimduo or Temixys, Emtriva, Epivir-HBV, Hepsera, Truvada, Viread, or Vemlidy (TAF), used for the treatment of hepatitis B. Use caution with drugs that negatively affect the kidneys, including chronic use or high doses of anti-inflammatory drugs for pain such as Advil or Motrin (ibuprofen) and Aleve (naproxen). Descovy should not be taken with certain anticonvulsants (including carbamazepine, oxcarbazepine, phenobarbital, and phenytoin), Aptivus/Norvir, rifabutin, rifampin, rifapentine, or St. John’s wort. Can be used with hepatitis C drugs such as Epclusa, Harvoni, or Zepatier. Tell your provider or pharmacist about all medications, herbals, and supplements you are taking or thinking of taking, prescribed or not, as there are other drug interactions which are not listed here.

Descovy is similar to Truvada, except that instead of TDF, Descovy contains TAF (tenofovir alafenamide), which reduces serum tenofovir concentration by up to 90%. This results in a decreased impact on kidney and bone demineralization but maintains potent antiviral activity in the CD4 cell. In clinical trials, fewer kidney and bone issues were observed with TAF than with TDF, and significant improvements were observed when switching from TDF to TAF. The long-term impact of TAF on patients with osteopenia or osteoporosis is unknown. Both Descovy and Truvada are currently recommended by DHHS HIV treatment guidelines for first-time therapy for most people, and in fact one or the other combination is found in some of the single-tablet regimens. Weight gain is being more commonly recognized as a potential side effect of TAF. In the community, enlargement of the stomach and waist area can be distressing. According to the DHHS HIV treatment guidelines, “Weight gain has been associated with initiation of ART [antiretroviral therapy] and subsequent viral suppression. The increase appears to be greater with INSTIs than with other drug classes. Greater weight increase has also been reported with TAF than with TDF, and greater with DOR than EFV.” Other factors have been associated with weight gain in addition to medication used, including race, sex, and previous overweight status. There is no word yet on reversibility, but the race is on to find more answers.

Descovy received FDA approval in October 2019 for the prevention of sexually acquired HIV (pre-exposure prophylaxis, or PrEP) in adults and adolescents weighing at least 77 pounds, excluding individuals at risk from receptive vaginal sex due to a lack of data in this population. It was studied in men who have sex with men and transgender women; other studies are ongoing. See Descovy for PrEP page. Because both FTC and TAF are also active against hepatitis B (HBV), Descovy is recommended by DHHS for individuals co-infected with both HIV and hepatitis B. Pediatric HIV guidelines recommend Descovy as part of a preferred regimen. TAF is now an alternative NRTI for use in pregnancy, according to DHHS perinatal guidelines updated in December. Descovy tablets are relatively small compared to Truvada and other combination tablets, which may be helpful to patients who have difficulty swallowing.

Dr. Melanie Thompson:

Coformulated tenofovir alafenamide and emtricitabine (TAF/FTC) is edging out TDF/FTC as the most popular nuke backbone because TAF has higher tenofovir levels in cells and lower levels in blood, resulting in less effect on kidneys and bone than TDF. Therefore, TAF is safe to use by people whose kidney function is somewhat impaired (estimated glomerular filtration rate equal to or greater than 30 mL/min).

Several recent developments may slow the trend toward TAF. Recent studies indicate that TAF may result in more weight gain than TDF, especially with INSTIs. Both HDL and LDL cholesterol levels are higher with TAF than TDF, although the HDL total cholesterol ratio remains unchanged, so the significance is not entirely clear. Finally, the approval of generic coformulations of TDF/3TC and TDF/FTC may offer a (somewhat) cheaper dual-nuke alternative for those able to take TDF.

Activist Bridgette Picou:

By now many people both HIV positive and negative have heard of “the little blue pill.” Descovy is the reformulation of Truvada. Tenofovir alafenamide fumarate replaces the tenofovir disoproxil in the original formulation. The alafenamide means less medication, and therefore lessened side effects on the body, namely kidney toxicity and bone density issues. Descovy is found in some of the newer STRs as well as fixed-dose tabs, and is also used for PrEP (see Descovy for PrEP).