Descovy for PrEP
Take a missed dose as soon as possible, unless it is closer to the time of your next dose. Do not double up on your next dose. Descovy for PrEP is not recommended if CrCl is between 15 to less than 30 mL/min or under 15 mL/min if you are not on dialysis.
- See Emtriva, which is contained in Descovy. TAF is available separately as Vemlidy.
- See package insert for more complete information on potential side effects and interactions.
gilead.com; descovy.com
(800) GILEAD-5 (445-3235)
JO-ANN JOSE, MD, MPH:
Descovy was approved following results of the DISCOVER clinical trial, which was comprised of nearly 5,400 men who have sex with men and transgender women who have sex with men. It did not look at ciswomen. It also did not include people who inject drugs or transgender men; therefore, Descovy is not approved for them. Is there any reason why Descovy wouldn’t work? Possibly, physiologically speaking, but it was not studied in those groups, so there are no data on them. That was an issue with the study’s design.
Descovy contains the newer TAF (tenofovir alafenamide) version of the HIV drug tenofovir, versus Truvada, which contains the older TDF (tenofovir disoproxil fumarate) formulation—that’s a key difference between Descovy and Truvada. Both medications are highly effective for PrEP. Oral adherence to a daily medicine can be challenging for some, so there are some issues with adherence. Long-acting injectable PrEP may provide a better option for someone who struggles to be adherent to oral meds, but it is important to note that when taken correctly, these oral meds work very well, and at a more competitive price point that’s easier for many people to access.
Do not take with any other HIV or HBV drugs (including Vemlidy, or TAF) when using Descovy for PrEP. Avoid taking Descovy 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 for PrEP can be used with the hepatitis C drugs Harvoni or Zepatier. Monitor for tenofovir toxicities if used with Epclusa. Descovy should not be taken with certain anticonvulsants (including carbamazepine, oxcarbazepine, phenobarbital, and phenytoin), rifabutin, rifampin, rifapentine, adefovir, or St. John’s wort. Concentrations of tenofovir, FTC, and other substances that clear the body through the kidneys could be increased (along with risk of toxicity) by the aminoglycoside antibiotics and the antivirals acyclovir, cidofovir, ganciclovir, valacyclovir, and valganciclovir. Tell your provider or pharmacist about all medications, herbals, and supplements you are taking or thinking of taking, prescribed or not.
The most common adverse event is diarrhea, observed in up to 5% of individuals given Descovy in the large DISCOVER study that led to FDA approval of Descovy for PrEP. There was also nausea (4%) and headache, fatigue, and abdominal pain (2% each). Check for hepatitis B virus (HBV) before taking Descovy and vaccinate against it if appropriate. If Descovy is discontinued abruptly in people with hepatitis B virus, flare-up of hepatitis may occur—talk to your provider before discontinuing. Drug resistance to HIV therapy may develop if people going on Descovy for PrEP unknowingly already have HIV, or if infection occurs after starting PrEP. However, drug resistance was rare in the extremely few individuals who acquired HIV during the DISCOVER trial (seven out of 2,670 persons on Descovy and 15 out of 2,665 on Truvada at the primary analysis). All were in the Truvada arm and all were in those with baseline HIV infections. As with previous PrEP studies, DISCOVER found the effectiveness of Descovy for PrEP was related to drug adherence—taking Descovy daily for PrEP as prescribed. The TAF component in Descovy is associated with relatively decreased risk for toxicity to the kidneys and bones (such as decreases in estimated glomerular filtration rate, or eGFR, and bone mineral density, or BMD) when compared to TDF in Truvada. Kidney function (including creatinine clearance, or CrCl) should be monitored while taking Descovy for PrEP. Recommended monitoring also includes STI screening. When comparing TDF versus TAF, bone changes may be of greater concern for young people whose bone structure is still growing and for older individuals who may be becoming frail. Bone mineral density (BMD) tests may be recommended in people with history of or risk factors for bone fractures or osteoporosis. Kidney changes may be of greater concern for individuals who have pre-existing kidney problems or older individuals at risk of developing kidney problems. Stigma remains a significant concern of HIV prevention, especially PrEP. When taken for HIV treatment, TAF has been associated with weight gain; SEE Descovy page.
Descovy for PrEP is not approved for the prevention of HIV via receptive vaginal sex. This is because the effectiveness of Descovy for PrEP was not evaluated in this population. A large study using Descovy for PrEP in cisgender women and adolescent girls, called PURPOSE-1, is underway. Individuals should be tested for HIV at least every 3 months while taking Descovy for PrEP. The tenofovir alafenamide (TAF) in Descovy and the tenofovir disoproxil fumarate (TDF) in Truvada (the first PrEP medication on the market) absorb, distribute, and concentrate differently in the body, but both are highly effective against the virus whether for treatment or prevention. TAF has less of a negative effect on renal function and bone mineral density than TDF, but the long-term clinical significance of the changes observed with the two medications remains unknown. Medical providers, however, prefer TAF over TDF for certain people who may be at higher risk for renal and bone toxicity (including youths and older individuals). Insurers must cover PrEP and its associated services (such as STI testing) without cost (such as co-pays) to people, but the details of coverage can vary and there was a significant legal challenge at the time of publication. A guide to help providers bill for PrEP services is available at nastad.org/resource/billing-coding-guide-hiv-prevention. Two excellent websites for finding a PrEP provider are preplocator.org and aidsvu.org—although any provider can prescribe PrEP. For more information, GO TO cdc.gov/hiv/basics/prep.html. Gilead Sciences helps people work with their insurance, including pre-authorizations, as well as provides free PrEP to uninsured people who are eligible and co-pay assistance for insured individuals up to $7,200 a year; contact the patient assistance hotline 24/7 at (877) 505-6986, or GO TO gileadadvancingaccess.com. PrEP Facts: Rethinking HIV Prevention and Sex is a closed Facebook group for people interested in or currently on PrEP, and their allies.
Pregnant individuals can voluntarily enroll in the Antiretroviral Pregnancy Registry through their provider; GO TO apregistry.com.
Activist Joey Wynn:
Descovy is just as effective as Truvada. Despite its sparkling label as a “superior option,” as I mentioned in the Truvada for PrEP page, if you don’t have kidney or bone issues with Truvada, you don’t need to switch to Descovy. And most pressingly, Descovy isn’t approved for use among women and other people with vaginal tissue because it was never studied among their demographic. It’s not too late for its manufacturers to correct that.