By Matt Pizzuti
Since 2012, HIV PrEP (Pre-Exposure prophylaxis) has been synonymous with Truvada. That’s because Truvada was the only daily pill with FDA approval for long-term use in preventing HIV infections. Since then, PrEP has been a huge success—helping to cut the rate of new HIV infections by as much as two thirds in some major U.S. metro areas—with very few side-effects. The problems that do occur in a few individuals include mild, reversible bone density loss, and kidney problems in some users, particularly those who are older.
For some people, those uncommon side-effects have meant that not everyone has been able to take advantage of PrEP. That’s why the introduction of a second PrEP option, Descovy, is such an important development. This month the FDA approved Descovy for PrEP for gay men and trans women at risk for HIV, putting a second option on the market to give PrEP users or those considering PrEP a choice. Descovy uses a different form of one of the two antiretroviral drugs that are combined in Truvada, it is effective at a lower dose (meaning a smaller pill), and it isn’t associated with the uncommon kidney problems or bone density changes that Truvada users experience. That means that for some individuals who are at risk for HIV and didn’t respond well to Truvada, this new drug is an opportunity to consider going on PrEP.
If you are already on PrEP or are thinking of starting it, you may be wondering if you should use Descovy instead. That choice is ultimately up to you and something you might want to discuss with your doctor, but for most people, there’s no strong reason not to stay on Truvada. Truvada has been extremely effective as PrEP, the side-effects are rare and reversible when they appear, and if you haven’t experienced any problems or are already successfully taking the medicine, it’s unlikely that any issues would pop up in the future. On top of that, Truvada is soon to go off-patent in 2020 and is about to become considerably less expensive in generic form.
In addition to Truvada and Descovy, there are other PrEP options that are still being investigated in clinical studies. In the future, there may be injectable forms of long-acting PrEP so you don’t have to worry about taking a pill every day, though they are still a long way off.
In the meantime, the addition of a new kind of PrEP is great news for our community. It expands access for those who didn’t tolerate Truvada and gives people more of a sense of control and freedom, which is why PrEP has been so exciting in the first place. Although Truvada has been generally well-tolerated and switching won’t be necessary for most people, don’t hesitate to ask your prescriber if you want to know more about your options now that a second drug is here.