Viread

Generally well tolerated, but some people may experience nausea, diarrhea, vomiting, and gas. Decreases in bone mineral density (BMD) have been observed. BMD monitoring should be considered for people who have a history of bone fracture due to bone 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. Viread may cause kidney toxicities. Creatinine clearance (CrCl) should be assessed before initiating treatment. In addition to CrCl, glucose and protein in the urine and serum phosphorus should be monitored more often in people at risk for kidney problems. 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 Viread (because TDF also treats 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 discontinuation of Viread. 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. Viread’s formulation contains lactose, which can cause some abdominal discomfort, especially in people sensitive to lactose.

Do not take with Cimduo or Temixys, Descovy, Hepsera, Truvada, or Vemlidy, all used for the treatment of hepatitis B. Viread decreases levels of Reyataz; therefore, Reyataz 300 mg must be boosted with Norvir 100 mg or Tybost 150 mg (taken together with food) when used in combination with TDF. Kaletra, Prezista/Norvir, and Reyataz/Norvir increase Viread levels, but there is no dose adjustment needed. People taking Kaletra, Prezista/Norvir, or Reyataz/Norvir with TDF should be monitored for Viread side effects (including kidney disorders) due to the higher TDF levels. Do not take Viread with adefovir. Avoid taking Viread with drugs that negatively affect the kidneys, including chronic use or high doses of NSAIDS (non-steroidal anti-inflammatory drugs) for pain, such as Advil or Motrin (ibuprofen) and Aleve (naproxen). Viread may be used with hepatitis C drugs such as Harvoni or Zepatier, depending on the other components 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.

TDF with emtricitabine (as Truvada) and TDF with lamivudine (as Cimduo or Temixys) are NRTI combinations recommended by DHHS HIV treatment guidelines for first-time therapy. Tenofovir alafenamide (TAF) has replaced TDF in certain fixed-dose combinations. Biktarvy, Genvoya, Odefsey, and Symtuza are four single-tablet regimens containing TAF instead of TDF. Descovy is similar to Truvada, but it combines emtricitabine with TAF instead of TDF. In clinical trials, TAF had fewer kidney and bone issues than TDF. The NIH reported infants exposed in the womb to TDF may have lower bone mineral content than those exposed to other antivirals. Tenofovir DF was approved in 2012 as part of Truvada for HIV prevention as PrEP (pre-exposure prophylaxis; see “Truvada for PrEP” page). TDF is part of the single-tablet regimens Atripla, Symfi, Symfi Lo, Complera, Delstrigo, and Stribild. Truvada, Cimduo, and Temixys are recommended by DHHS as part of the preferred NRTI combination components of an ART regimen during pregnancy. Pregnant individuals can voluntarily enroll in the Antiretroviral Pregnancy Registry through their provider; go to apregistry.com.

Dr. Melanie Thompson:

The “original” tenofovir, tenofovir disoproxil fumarate (TDF) is used for both HIV and hepatitis B treatment (at different doses) and is generally given with FTC or 3TC. Its most worrisome side effects are kidney toxicity and loss of bone density, especially when used with a ritonavir or cobicistat booster, or when used by persons with other risk factors for kidney disease or bone loss. For further information, see Truvada.

Activist Michael Broder:

Viread (tenofovir disoproxil fumarate, TDF), approved in 2001) is an NRTI, and was the first HIV drug brought to market by Gilead Sciences, the market leader in drugs to treat and prevent HIV (in a decades-long rivalry with ViiV Healthcare). In 2003, Gilead acquired Triangle Pharmaceuticals, along with its newly approved NRTI, emtricitabine (Emtriva), and combined the two drugs into the blockbuster fixed-dose combination (FDC) Truvada. Viread is potent, tolerable, convenient, and has a good resistance profile. Its downside is its negative impact on bones and kidneys, which makes its safety questionable, especially for people under age 25, who are still actively developing bone, and for people who have even mild to moderate kidney disease. Nowadays, there are a number of safer alternatives to Viread. If your provider recommends a Viread-containing regimen, they may well have a good reason, but make sure they tell you what it is.