Truvada

Overall, Truvada is well tolerated, but some may experience nausea, headache, bloating, stomach pain, or weight loss. Rare skin discoloration on palms and soles may also occur. The TDF in Truvada is associated with long-term decreases in bone mineral density (BMD). BMD monitoring should be considered in people who have a history of bone fracture due to disease or are at risk for osteopenia or osteoporosis. While calcium and vitamin D levels can be checked to assess the need for these supplements, talk with your provider before starting on your own. Truvada can cause kidney toxicities. 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 kidney problems. Routine monitoring of estimated creatinine clearance, serum phosphorus, urine glucose, and urine protein should be performed in all individuals with mild kidney impairment. If you have HIV and HBV, guidelines recommend treatment for both viruses. Truvada can be used to treat HIV and HBV simultaneously. If you are co-infected with HBV and HIV, you should not stop Truvada without medical supervision because it can cause your HBV to flare and cause you to experience signs and symptoms of acute hepatitis. HBV should be closely monitored by your provider. Truvada is associated with lower lipid levels than Ziagen or tenofovir AF (TAF) due to tenofovir DF’s favorable effect on LDL (bad) cholesterol (although it also lowers levels of HDL, or good cholesterol). The ratio of total cholesterol to HDL remains the same as that of tenofovir AF. Truvada contains lactose, which can cause some abdominal discomfort, especially in patients sensitive to lactose.

Do not take with Epivir-HBV, Hepsera, Descovy, or Vemlidy (TAF), used for the treatment of hepatitis B. Tenofovir decreases the concentration levels of Reyataz, therefore when Reyataz is taken with Truvada or Viread, it is recommended that Reyataz 300 mg is taken with Norvir 100 mg or Tybost 150 mg (all as a single daily dose with food). In addition, Reyataz/Norvir, Prezista/Norvir, and Kaletra increase tenofovir concentrations. It is recommended that patients taking Reyataz/Norvir, Prezista/Norvir, or Kaletra with Truvada should be monitored for Truvada-associated adverse events, particularly decreases in kidney function. Avoid taking Truvada with drugs that negatively affect the kidneys, including chronic use or high doses of anti-inflammatory drugs for pain like Advil or Motrin (ibuprofen) and Aleve (naproxen). Truvada may be used with hepatitis C drugs Harvoni or Zepatier, depending on the third drug in the HIV regimen; monitor for tenofovir toxicities if used with Epclusa. 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 not listed here.

Don’t believe the hucksters: Truvada is a safe medication to take. As with any drug therapy, some people will experience side effects. Adverse events are rare and usually reversible. See “Truvada Safety” in the September+October 2019 issue of Positively Aware (positivelyaware.com/articles/truvada-safety). Current DHHS HIV treatment guidelines recommend Truvada (or Descovy) over Epzicom as the preferred NRTI component for initial therapy (unless Epzicom is paired with Tivicay). The newer version of Truvada, called Descovy, was approved in 2016. The ACTG A5202 study reported that while both Epzicom and Truvada reduced viral load, for those people who started treatment with a viral load of more than 100,000 copies/mL, the times to virologic failure and the first adverse event were both significantly shorter in patients taking Epzicom compared to Truvada. In studies using Tivicay in the regimen, however, Truvada and Epzicom were equally effective regardless of baseline viral load. Kidney function must be monitored before and during treatment with Truvada and it may not be a good option for patients with underlying kidney problems. Fewer kidney and bone issues were observed with the TAF formulation compared to TDF in clinical trials. Truvada was approved in 2012 for HIV prevention (pre-exposure prophylaxis, or PrEP) in confirmed HIV-negative adults; see Truvada for PrEP page. In October 2019, Descovy also received FDA approval as PrEP for sexually-acquired HIV for adults and adolescents weighing at least 77 pounds, excluding individuals at risk from receptive vaginal sex; see Descovy for PrEP page. Truvada is recommended by DHHS as one of the preferred NRTI combination components of an ART regimen in pregnancy.

Dr. Ross Slotten says:

Truvada was approved in 2004 (on the same day as Epzicom, see that page) as a two-drugs-in-one-pill, two-nuke combination “backbone” to which a third drug is added to create a three-drug combination or “cocktail” ART regimen. Truvada was the most commonly prescribed antiretroviral for the majority of PLWH from the late 2000s until Descovy was approved in 2016. This was due to Truvada’s solid track record as a potent, well-tolerated, and durable two-nuke combination, data showing its higher potency over Epzicom, and concerns (still controversial) about Epzicom’s cardiovascular side effects. Truvada’s use has steadily declined since the approval of four TAF-containing medications (Biktarvy, Genvoya, Odefsey, and Descovy) due to less long-term side effects (kidney and bone strength). Truvada became the first medication approved for pre-exposure prevention (PrEP) of HIV in 2012. In mid-December 2017, a generic form of Truvada was approved in the U.S. With the availability of TAF-containing medications, the use of generic Truvada, while probably less expensive, has yet to be seen.

Dr. Ross Slotten says:

Truvada was approved in 2004 (on the same day as Epzicom, see that page) as a two-drugs-in-one-pill, two-nuke combination “backbone” to which a third drug is added to create a three-drug combination or “cocktail” ART regimen. Truvada was the most commonly prescribed antiretroviral for the majority of PLWH from the late 2000s until Descovy was approved in 2016. This was due to Truvada’s solid track record as a potent, well-tolerated, and durable two-nuke combination, data showing its higher potency over Epzicom, and concerns (still controversial) about Epzicom’s cardiovascular side effects. Truvada’s use has steadily declined since the approval of four TAF-containing medications (Biktarvy, Genvoya, Odefsey, and Descovy) due to less long-term side effects (kidney and bone strength). Truvada became the first medication approved for pre-exposure prevention (PrEP) of HIV in 2012. In mid-December 2017, a generic form of Truvada was approved in the U.S. With the availability of TAF-containing medications, the use of generic Truvada, while probably less expensive, has yet to be seen.