Descovy

Overall, Descovy is well tolerated, but some people may experience nausea, headache, stomach pain, or changes in weight. Data associate INSTIs and TAF with potential weight gain. 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. New TAF information as of last year: “Post-marketing cases of renal [kidney] impairment, including acute renal failure, proximal renal tubulopathy (PRT), and Fanconi syndrome have been reported with TAF-containing products; while most of these cases were characterized by potential confounders that may have contributed to the reported renal events, it is also possible these factors may have predisposed people to tenofovir-related adverse events.” At initiation and during treatment, assess kidney lab tests: serum creatinine, estimated creatinine clearance, urine glucose, and urine protein. In people with chronic kidney disease, also assess serum phosphorus. Discontinue Descovy in people who develop clinically significant decreases in kidney function or signs of Fanconi syndrome. 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 HBV who have discontinued Descovy (due to elimination of both emtricitabine and TAF, which also treat hepatitis B). Monitor liver enzymes closely in people co-infected with HBV 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 that are not listed here.

Descovy is similar to Truvada, except that instead of TDF (tenofovir disoproxil fumarate), 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 people 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—in fact, one or the other combination is found in some of the single-tablet regimens. Descovy can be used for HIV prevention; 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 HBV. Pediatric HIV guidelines recommend Descovy as part of a preferred regimen. TAF is an alternative NRTI for use in pregnancy, according to DHHS perinatal guidelines. Descovy tablets are relatively small compared to Truvada and other combination tablets, which may be helpful to people who have difficulty swallowing. Pregnant individuals can voluntarily enroll in the Antiretroviral Pregnancy Registry through their provider; go to apregistry.com.

Dr. Melanie Thompson:

Descovy is Truvada with the newer version of tenofovir, TAF, substituted for TDF. Along with Truvada, it is recommended for initial therapy for most people in combo with an INSTI anchor drug. TAF/FTC is also included in Symtuza and Odefsey. Clinical trials found TAF to be associated with lower rates of biomarkers for kidney impairment and bone density loss than TDF, owing to higher intracellular and lower blood levels of tenofovir. Much is made of Descovy being “safer” than Truvada, but, in my opinion, these changes are often not clinically significant for young, healthy people without comorbidities, and for anyone not taking booster drugs. LDL and HDL cholesterol and weight gain are higher with Descovy than Truvada. Like Truvada, Descovy is active against hepatitis B, owing to the activity of both TAF and FTC. 

Because of reassuring data from the Antiretroviral Pregnancy Registry, TAF is now recommended as an alternative drug in pregnancy by the DHHS Perinatal Guidelines panel.

Activist Michael Broder:

I am on a Descovy-containing regimen. TAF may be safer than TDF for bones and kidneys. This is especially important for people under age 25, who are still actively developing bone, and for people who have mild to moderate kidney disease. On the other hand, TAF has a worse profile than TDF when it comes to cholesterol and weight gain. Providers will weigh the choice based on their experience, and on the needs of each patient.