The FDA has approved Descovy for HIV PrEP for sexual exposures, except vaginal receptive sex. This approval was based on the DISCOVER study of 5,000 men who have sex with men (MSM) and transgender women (TGW) comparing Descovy (emtricitabine/tenofovir alafenamide) and Truvada (emtricitabine/tenofovir disoproxil fumarate); Descovy was non-inferior to Truvada for HIV prevention.
There was no difference in adverse events or safety. There was less bone loss and kidney involvement with Descovy; however, the clinical significance of this difference is unclear.
Importantly, greater weight gain and increase in LDL was seen with Descovy compared to Truvada.
Summary of Recommendations:
· Truvada is the preferred regimen for most patients.
· For patients taking Truvada for PrEP (Daily or 2-1-1): Continue Truvada.
· Renal Disease: Descovy preferred for MSM and TGW with a non-isolated CrCl between 30-60 mL/min.
· Bone Disease: Consider Descovy on a case-by case basis for MSM and TGW with osteoporosis/osteopenia or bone disease risk factors.
· Patients requesting Descovy with no contraindication to Truvada use: Recommend Truvada.*
· Patients requesting Descovy due to potential side effects to Truvada: Consider Descovy and assess for symptom improvement.
· Insufficient data to support Descovy use: Heterosexual women, transgender men, people who inject drugs, 2-1-1 (On-Demand) PrEP. In these populations, Descovy may be considered on a case-by-case basis for patients who are at risk for HIV and have contraindications to Truvada use.
* Given the importance of shared decision making and patient empowerment, Descovy may be considered on a case-by-case basis for any patient who continues to express a preference for Descovy after informed discussion of the data and rationale described herein.
Here is a nice comparison of Truvada and Descovy from Dr. Julia Marcus:
