Descovy vs Truvada: How do they compare for HIV / PrEP?

Truvada and Descovy are both two-drug, antiviral combinations containing emtricitabine and tenofovir for the treatment of HIV-1 infection, and for pre-exposure prophylaxis (PrEP) to reduce the risk of HIV-1 infection. The key difference between these two medications is the type of tenofovir:

• Descovy contains tenofovir alafenamide (TAF), a newer form with fewer kidney and bone-related side effects.
• Truvada contains tenofovir disoproxil fumarate (TDF), the original form of tenofovir.

Both drugs are effective, but their approved uses, side effects, and costs differ. Below, we will review some key differences between Truvada and Descovy.

What are Truvada and Descovy?

Truvada and Descovy are oral antiviral medications used to treat and prevent HIV infection. Truvada contains emtricitabine and tenofovir disoproxil fumarate, while Descovy contains emtricitabine and tenofovir alafenamide. Both medications contain emtricitabine, but the form of tenofovir in each differs.

Truvada is an older medication, and was first FDA approved in 2004. Descovy was more recently approved in 2016 for treatment of HIV infection, and in 2019 for HIV PrEP. Both medications are manufactured by Gilead Sciences, Inc. Neither medication cures an HIV infection, but they can help keep it suppressed.

While both medications are FDA approved to prevent HIV infection, Descovy isn’t approved in people at risk for HIV from receptive vaginal sex. There is not enough data to know how well it works in this population. It also isn’t recommended for people likely to get HIV from injection drug use. Truvada can be used in both of these situations.

Indication	Truvada	Descovy
HIV Treatment	Approved for adults and children 12 years and older ≥35 kg (77 lbs), combined with other antiretrovirals.	Approved for adults and children ≥14 kg (31 lbs), combined with other antiretrovirals.
HIV PrEP	Approved for adults and adolescents ≥35 kg (77 lbs), including those at risk from vaginal sex.	Approved for adults and adolescents ≥35 kg (77 lbs), but not recommended for vaginal sex or injection drug use risk.

How do Truvada and Descovy work?

Truvada and Descovy combine two antiviral medications in one tablet. Both ingredients, emtricitabine and tenofovir, belong to the drug class known as nucleoside analog reverse transcriptase inhibitors (NRTIs).

Usually, HIV uses a protein called reverse transcriptase to make DNA from its RNA. Emtricitabine and tenofovir work by blocking this protein, which stops HIV from multiplying in your body.

When taken daily, these medications maintain stable drug levels to prevent HIV infection and suppress the virus in those already infected.

How do you take Truvada and Descovy?

Truvada and Descovy are both available as oral tablets. Truvada comes in four different strengths:

• 100 mg emtricitabine/150 mg tenofovir disoproxil fumarate
• 133 mg emtricitabine/200 mg tenofovir disoproxil fumarate
• 167 mg emtricitabine/250 mg tenofovir disoproxil fumarate
• 200 mg emtricitabine/300 mg tenofovir disoproxil fumarate

Descovy comes in two strengths:

• 120 mg emtricitabine/15 mg tenofovir alafenamide
• 200 mg emtricitabine/25 mg tenofovir alafenamide

Both medications are typically taken by mouth once a day in people with healthy kidneys. The tablets can be taken with or without food. Below is the FDA-approved dosing, but there are also off-label dosing regimens (e.g., 2-1-1 dosing for oral PrEP) that healthcare providers might recommend in certain situations.

Dosing for Truvada

The dosing for Truvada depends on the reason you are taking it and your body weight.

HIV treatment: For people who weigh at least 35 kg (77 lbs), the recommended dose is one 200 mg/300 mg tablet once daily. For people who weigh 17 kg (37 lbs) to 34 kg (75 lbs), the dose depends on body weight.

• 17 to 21 kg: one 100 mg/150 mg tablet once daily
• 22 to 27 kg: one 133 mg/200 mg tablet once daily
• 28 to 34 kg: one 167 mg/250 mg tablet once daily

HIV PrEP: For people who weigh at least 35 kg (77 lbs), the recommended dose is one 200 mg/300 mg tablet once daily.

The dose is usually adjusted for people with kidney problems, or might not be recommended at all.

Dosing for Descovy

Similar to Truvada, the dosing for Descovy depends on the reason you are taking it and your weight.

HIV treatment: For people who weigh at least 25 kg (55 lbs), the recommended dose is one 200 mg/25 mg tablet once daily. For people who weigh 14 kg (31 lbs) to 24 kg (53 lbs), the recommended dose is one 120 mg/15 mg tablet once daily.

HIV PrEP: For people who weigh at least 35 kg (77 lbs), the recommended dose is one 200 mg/25 mg tablet once daily.

Dose adjustments are not recommended in people with mild-to-moderate liver or kidney problems, but it might not be the best option for you if you have severe liver or kidney disease.

How Effective Are Descovy and Truvada?

Both Descovy and Truvada work well when added to other antiretrovirals for treatment of HIV infection. How effective each treatment is depends on factors like other treatments and adherence.

Descovy vs. Truvada For HIV Treatment

• Descovy: Clinical trials showed 92–96% of patients achieved an undetectable viral load at 48 weeks.
• Truvada: Clinical trials showed 80% of patients maintained an undetectable viral load at 48 weeks.

Descovy vs. Truvada For HIV PrEP

Both drugs are estimated to be 99% effective at preventing HIV through sex when taken daily. They may also be over 74% effective when taken for risk of HIV due to injection drug use, but only oral tenofovir alone has been studied. Both medications work best starting around after 7 days of daily use.

A study including over 5,000 participants comparing Descovy with Truvada for HIV prevention from sex found that Descovy worked just as well as Truvada. After up to 96 weeks of follow-up, the rate of HIV-1 infections per 100 person-years was 0.16 and 0.34 for Descovy and Truvada, respectively. For both treatments, efficacy was strongly related to how well participants adhered to daily dosing. Of note, the study only included HIV-negative men or transgender women who have sex with men.

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What are the side effects of Descovy and Truvada?

Both medications can cause nausea, diarrhea, and headaches, but Descovy is associated with fewer kidney and bone-related side effects.

Side effects: Descovy

For HIV-1 treatment in adults, the safety of Descovy was evaluated in multiple 48-week studies in patients also taking elvitegravir and cobicistat. Nausea was the most common side effect, occurring in 10% of people. In two 48-week studies, 10% of adults experienced a decline in bone mineral density (BMD) at the lumbar spine by 5% or more. Similar side effects were seen in children, except BMD increased in most adolescents.

The following side effects were reported by ≥2% of people taking Descovy for PrEP during a clinical trial that included 2,694 participants:

• Diarrhea (5% vs. 6% Truvada)
• Nausea (4% vs. 5% Truvada)
• Headache (2% vs. 2% Truvada)
• Fatigue (2% vs. 3% Truvada)
• Stomach pain (2% vs. 3% Truvada)

Descovy also carries warnings for worsening of hepatitis B infection, immune reconstitution syndrome, kidney problems, as well as lactic acidosis and severe hepatomegaly with steatosis (enlarged liver).

Side effects: Truvada

The safety of Truvada for HIV treatment was evaluated in adults during a 144-week clinical trial. Participants took efavirenz together with either Truvada or zidovudine/lamivudine.

The following side effects were reported by ≥5% of people taking Truvada for HIV treatment:

• Fatigue (9%)
• Depression (9%)
• Nausea (9%)
• Diarrhea (9%)
• Dizziness (8%)
• Upper respiratory tract infections (8%)
• Sinus infection (8%)
• Rash (7%)
• Headache (6%)
• Trouble sleeping (5%)
• Common cold (5%)

Side effects were similar in children, with the exception of anemia (7%) and hyperpigmentation (32%) reported in addition.

For HIV PrEP, Truvada was studied in adults for up to 71 and 87 weeks during two clinical trials. The following side effects were reported by ≥2% of people taking Truvada for PrEP:

• Headache (7%)
• Stomach pain (4%)
• Weight loss (3%)

In addition, 13% of adults taking Truvada for PrEP experienced at least 5% of their bone mineral density at the spine. Side effects in children were similar to those seen in adults, with the exception of bone mineral density changes. In adolescents, BMD increased at the spine and total body through 48 weeks. However, total BMD gain was less in children taking Truvada compared to another treatment.

Similar to Descovy, Truvada carries warnings for worsening of hepatitis B infection, immune reconstitution syndrome, kidney problems, as well as lactic acidosis and severe hepatomegaly with steatosis (enlarged liver). It additionally has a warning for bone loss and mineralization defects.

Cost Comparison: Descovy vs. Truvada

Descovy is available as a brand-name product, while Truvada comes in both brand-name and generic versions. The manufacturer offers patient assistance programs. You can call 1-800-226-2056 to speak with a program specialist Monday through Friday, 9 AM to 8 PM ET or visit the website.

• Based on the Drugs.com Truvada Price Guide, a one-month supply of Truvada (100 mg-150 mg) costs around $1,933.
• Based on the Drugs.com Descovy Price Guide, a one-month supply of Descovy (120 mg-15 mg) costs around $2,329.

Note: Cash prices are estimates using the Drug.com Drug Discount Card and are subject to change. Cost can vary for these medicines depending upon your pharmacy and location, your insurance and copays, deductibles, patient financial assistance or any discount coupons you may have.

This is not all the information you need to know about Descovy or Truvada for safe and effective use and does not take the place of your healthcare provider’s directions. Review the full patient medication guide and discuss this information and any questions you have with your doctor or other health care provider.

Descovy vs. Truvada comparison chart

	Truvada	Descovy
Initial FDA Approval	August 2, 2004	April 4, 2016
Generic Name	emtricitabine and tenofovir disoproxil fumarate (TDF)	emtricitabine and tenofovir alafenamide (TAF)
How Supplied	Tablets emtricitabine 200 mg / TDF 300 mg emtricitabine 167 mg / TDF 250 mg emtricitabine 133 mg / TDF 200 mg emtricitabine 100 mg / TDF 150 mg	Tablets emtricitabine 120 mg / tenofovir alafenamide 15 mg emtricitabine 200 mg / TAF 25 mg
Indications	HIV-1 Infection in adults and pediatric patients 12 years and older weighing at least 35 kg (in combination with other antiretroviral agents) Pre-Exposure Prophylaxis (PrEP) in at-risk adults and adolescents weighing at least 35 kg	HIV-1 Infection in adults and pediatric patients weighing at least 14 kg (in combination with other antiretroviral agents) Pre-Exposure Prophylaxis (PrEP) in at-risk adult and adolescent men and transgender women weighing at least 35 kg

Truvada and Descovy are both manufactured by Gilead Sciences Inc.