Truvada

Overall, Truvada is well tolerated, but some people 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 for 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 bone or 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. 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 Truvada (due to elimination of both emtricitabine and TDF, 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 Truvada 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. Truvada is associated with lower lipid levels than Ziagen or TAF due to TDF’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 TAF. Truvada contains lactose, which can cause some abdominal discomfort, especially in people sensitive to lactose.

Do not take with Cimduo or Temixys, Descovy, Emtriva, Epivir-HBV, Hepsera, Vemlidy, or Viread, all used for the treatment of hepatitis B. Tenofovir DF decreases the concentration levels of Reyataz, therefore when Reyataz is taken with Truvada or Viread, it is recommended that Reyataz 300 mg be 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 DF concentrations. It is recommended that people 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 such as 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 lawsuit advertisers: 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. 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 ACTG A5202 study reported that while both Epzicom and Truvada reduced viral load, for 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 among people 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 people who have underlying kidney problems or are at higher risk for them. Fewer kidney and bone issues were observed with the TAF formulation compared to TDF in clinical trials. Truvada is approved for HIV prevention; see “Truvada for PrEP” page. Truvada is recommended by DHHS as one of the preferred NRTI combination of HIV treatment in pregnancy. Pregnant individuals can voluntarily enroll in the Antiretroviral Pregnancy Registry through their provider; go to apregistry.com.

Dr. Melanie Thompson:

Tenofovir disoproxil fumarate (TDF) rose to predominance as a backbone because of lower toxicity than AZT and the “d-drugs” (d4T, ddI, ddC) and its high genetic barrier to resistance. It also has potent activity against hepatitis B. Today it is almost always given with FTC or 3TC as in Truvada, Cimduo, and Temixys.

While diarrhea, nausea, and fatigue were the most common side effects seen in early clinical trials, side effects of highest concern include a potential for kidney toxicity, mostly mild but occasionally serious, and decrease in bone density. Serious toxicities are most often seen in people with other risks for kidney disease or low bone density, including older age or comorbidities, or when taken in combination with ritonavir or cobicistat. TDF also lowers LDL and HDL cholesterol and is associated with a bit of weight loss. TDF/FTC is safe in pregnancy.

Activist Michael Broder:

Approved in 2004, Truvada is a fixed-dose combination (FDC) of two NRTIs (emtricitabine and tenofovir disoproxil fumarate, TDF). Truvada is recommended in combination with Tivicay for most people starting therapy for the first time. The components of Truvada are included in the single-tablet regimens Atripla, Stribild, and Complera. Truvada has largely been supplanted by Descovy, which replaces the TDF in Truvada with tenofovir alafenamide (TAF). TAF may be safer than TDF for bones and kidneys. This is especially important for people under 25, who are still actively developing bone, and for people who have mild to moderate kidney disease. On the other hand, TDF may be better than TAF when it comes to cholesterol and weight gain. If your provider recommends Truvada rather than Descovy, they may well have a good reason, but make sure they tell you what it is.