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AIDS and HIV Information

AIDS and HIV Information

Descovy vs Truvada

Descovy and Truvada, both manufactured by Gilead Sciences, are similar drugs. Descovy is actually the updated version of Truvada. The two regimens contain emtricitabine (FTC) and tenofovir, but Descovy, the recently approved fixed-dose combination tablet, contains the newer prodrug tenofovir alafenamide (TAF) rather than tenofovir disoproxil fumarate (TDF).

What is the difference between Descovy and Truvada?

While dramatic improvements have been happening since the introduction of antiretroviral therapies (ART) in the 90s, anti-HIV agents are continuously being upgraded. Initially potent and widely used medicines are being replaced by newer and safer drugs, thanks to ongoing observational studies and clinical trials. Official HIV guidelines would routinely issue updated recommendations to reflect recent findings and clinical evidence. In the case of Truvada, the impeding drug is TDF. Although the drug is undoubtedly potent, given its stellar performance in various research studies, it is somehow associated with kidney impairment and bone loss. Because ART-users are bound to take their meds indefinitely, it’s very crucial to come up with drugs that have fewer side effects and risks, especially for long-term use.
The advent of tenofovir alafenamide is a welcome discovery for HIV patients who will be taking ART for the rest of their lives. It is reported to be safer on the kidneys and bones. However, one should take note that just like TDF, TAF will still be converted in the body as the active agent tenofovir. But TAF has the advantage of delivering tenofovir diphosphate to the T-cells more efficiently. Because smaller doses of TAF produce high drug levels in the HIV-infected cells and lower concentrations in the blood, the kidneys, bones, and other tissues and organs are less exposed to the drug.  

Descovy

 

Truvada

Contains emtricitabine and tenofovir alafenamide

Ingredients

Contains emtricitabine and tenofovir disoproxil fumarate

Approved in April 2016 for treatment of people with HIV-1 infection

FDA Approval Status

Approved in 2004 for HIV treatment and in 2012 as PrEP

Take one 200mg/25mg oral tablet once daily

Dosage and Administration

Take one 200mg/300mg oral tablet once a day

Can be taken without regard to meal times

Food Interaction

Can be taken with or without food

Not approved for PrEP use

PrEP Usage

Recommended for pre-exposure prophylaxis and post exposure prophylaxis

Safer for kidneys and bones

Advantages

Proven to be relatively safe and effective against HIV infection and as preventive treatment for high-risk HIV-negative individuals

Lower drug concentrations in human rectal and genital tissues

Disadvantages

Associated with kidney function impairment and bone density loss

Nausea, headache, fatigue, diarrhea

Side Effects

Nausea, vomiting, stomach pain, diarrhea, headache

No generic version available. Patent is set to expire on 2022

Generic Version

Generic equivalent have been approved

Starts at around $1,650 per 30 tablets

Cost

Starts at around $1,300 per 30 tablets

Can Descovy be used for PrEP?

Truvada is currently the only approved regimen for PrEP use. In the iPrEx OLE study, Truvada showed 99% estimated efficacy in men and transgender women who have sex with men, provided they adhere well to the daily regimen. Truvada works in combination with other antiretroviral agents to fight existing HIV infection, but it can also be used alone to prevent getting infected by the virus. Since Descovy and Truvada contain similar ingredients, can high-risk patients use Descovy for PrEP instead of Truvada?
While both drugs contain emtricitabine and tenofovir prodrugs, they don’t exert the same level of efficacy. As HIV treatment, Descovy is not inferior to Truvada. Based on Phase 3 clinical trials, regimens containing TAF demonstrated 90% efficacy and participants achieved undetectable viral load at 48 weeks. Additionally, those on TAF regimens had less bone loss and more favorable kidney function results. However, that may not be the case when using Descovy as PrEP.


In an early human study, TAF concentrations in rectal and genital tissue samples were found to be lower than expected levels. It is still not clear whether these findings mean lower effectiveness for Descovy as PrEP. But experts do not recommend the use of the new ART for preventive treatment until human trials are completed. The only favorable study for Descovy was performed in monkeys. The TAF-containing regimen was able to protect macaque subjects from rectal infection. Right now, Truvada is only PrEP regimen that is highly protective for anal sex. We still do not know if Descovy can do the same, but several trials are underway. Your doctor may still prescribe Descovy for PrEP use although it is not yet approved for such indication.

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