Truvada is used for both the treatment of HIV (in combination with one or more other drugs) and also for the prevention of HIV in people who are HIV negative. For HIV prevention, Truvada is a part of a strategy called pre-exposure prophylaxis, or PrEP, for short.
What are the drugs in Truvada?
It’s a pill made of two HIV-fighting drugs, emtricitabine (FTC) and tenofovir disoproxil fumarate (TDF).
How often is Truvada taken?
Truvada is normally taken by mouth once a day, with no food or timing restrictions, but please ask your health care provider about dosing, whether for HIV treatment or for PrEP.
Does Truvada have any side effects I should worry about?
It rarely causes side effects but may worsen long-term kidney and bone problems. Your doctor should regularly monitor you to make sure you don’t develop these side effects.
Can Truvada be used for any other conditions besides HIV treatment or prevention?
Truvada can be a good fit for people who have hepatitis B. Check with your physician to make sure you have been vaccinated for hepatitis B or to find out whether you have it before you stop or start taking Truvada.
Truvada is a combination medication (tenofovir disoproxil fumarate/emtricitabine) that is used for both HIV treatment and prevention. Both medications in Truvada were previously used separately as parts of HIV management, with tenofovir disoproxil fumarate (TDF) being available since 2001 and emtricitabine (FTC) on the market since 2003, respectively.
Truvada was first approved as part of an HIV treatment regimen by the Food and Drug Administration (FDA) in 2004, and it has been a part of combination antiretroviral treatment (ART) in a multitude of single-tablet regimens (STR), including Atripla, Complera, and Stribild. Up until a few years ago, it had enjoyed status as a consistent component of many of the first-line regimens recommended by the Department of Health and Human Services (HHS) Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV. In recent times, however, with the FDA approval of Descovy (tenofovir alafenamide/emtricitabine) as a potentially safer version of Truvada in a smaller package, that has changed.
One of the benefits of including Truvada as part of an initial or continued ART regimen is that not only is it effective in slowing down HIV, it is also useful in the treatment of hepatitis B. Both FTC and TDF are effective against hepatitis B, with FTC being considered not as strong of a treatment due to problems with resistance. TDF is a little more durable and less prone to resistance for the treatment of hepatitis B, so the two combined as part of a complete ART plan is a no-brainer if you are also living with chronic active hepatitis B. Essentially, Truvada is good for treating both viruses.
How to Take Truvada
Truvada, whether taken for treatment or as PrEP, is FDA-approved in the United States to be taken once daily, with or without food. Food does not impact absorption of either medication, but some may find that taking Truvada with food is easier on the stomach.
In some other countries, Truvada is also approved to be taken as PrEP in an “on-demand” fashion, so people can take two tablets anywhere from two to 24 hours before sex, then another pill 24 hours after the first two, and another pill 48 hours after the first two. Despite more recent evidence suggesting the effectiveness of “on-demand” PrEP in the United States, it has yet to receive FDA approval for this dosing strategy.
How Much Does Truvada Cost?
Much has been made about the pricing of Truvada, since there is no generic version available here in the United States (the first generic version will be available at the end of September 2020). No doubt this has a lot to do with varying quotes of the cost of the medication, ranging from $1,500 to $2,000 for a month’s supply. This is certain to scare many off who are considering Truvada for treatment, but much more so for those who might take PrEP, since they are considering it for HIV prevention.
Truth is, if you have insurance, monthly copays for Truvada typically run between $10 and $50, depending on the plan, though some people may pay a percentage of the actual pharmacy price (coinsurance). The manufacturer of Truvada has a copay assistance program to help people with commercial health insurance defray these out-of-pocket costs. For those who don’t have insurance and meet certain income requirements, the manufacturer also has a patient assistance program that provides the drug for free.
Side Effects of Truvada
While Truvada has been a safe and well-tolerated staple of ART for the past 15 years, the fear of potential side effect issues has always plagued it. We learned that Truvada was associated with renal toxicity and bone thinning early on, and these side effects, while rare, still stick in people’s mind when choosing options for HIV treatment.
These potential renal side effects are primarily attributed to TDF as a prodrug in Truvada that stays in the bloodstream for a long time before it reaches the immune system cells. Moreover, the risk for potential side effects may be more of an indication of older age, preexisting kidney disease, interactions with other medications, or damage from HIV itself.
Studies have confirmed the association of Truvada with these side effects in some patients who take it but also noted that these effects are reversable when the medication is stopped—and rarely lead to serious health problems. Truth is, any medication you take has a list of potential side effects, even the most common ones, like anti-inflammatories and fever-reducing medications. Always pay attention to the medications you are putting in your body, communicate with your medical provider, and follow up for your routine labs while you are on your meds. If you are currently taking Truvada for PrEP or treatment, it is likely that your medical team will be having you come in for labs every four to six months. That’s the best way to stay on top of things.
Truvada and Other Drug Interactions
Given the potential side effect of kidney damage, it is recommended to be careful when taking Truvada if you are on other medications that could harm the kidneys—anti-inflammatories, some antibiotics, and blood pressure meds could pose an issue, so make sure you discuss them with your medical provider.
Similarly, steroids like prednisone that can cause bone thinning should be avoided or used with caution when also taking Truvada. Truvada can also reduce concentrations of the HIV protease inhibitor atazanavir, so it must be boosted with ritonavir when these are taken together.
Finally, if you are transgender or gender nonbinary and taking estrogen, know that being on Truvada will not reduce the levels of hormones, but the estrogen can reduce the concentrations of TDF in Truvada. So, if you are taking Truvada for PrEP and on estrogen, make sure you are taking it daily as prescribed, as skipping doses could further reduce its concentration in the blood and make it less effective for HIV prevention.
Truvada as HIV Treatment
Whether combined with various other medications or as part of a single-tablet regimen (STR), Truvada has been a solid part of many an ART treatment that has kept people healthy and thriving for decades. For years it was the backbone of any ART regimen, particularly when initiating treatment for someone with a new HIV diagnosis.
Times change, however, and currently we know that nearly half of the population living with HIV in the United States is over 50 years of age. With that evolution comes some new considerations for both patients and health care providers when considering Truvada as a component of ART.
As people are living longer with HIV in today’s landscape, a shift has occurred for many from wondering, “Will I live to see tomorrow?” to “How can I thrive and live my best life for decades to come?” You can be faithful with your HIV medications and have an undetectable viral load, but now you also must think about other chronic health conditions like high blood pressure, diabetes, obesity, poor bone health, and chronic kidney disease.
As we have learned more about the potential chronic kidney and bone issues that may happen with some who are on Truvada, you should consider this when choosing what ART regimen you want to be on if you do live with some of these other medical conditions. If you have a family history of high blood pressure, diabetes, osteoporosis, or any kidney disease, bring this up with your medical team to discuss whether a treatment plan with Truvada would be a good idea.
This is where the rubber meets the road when it comes to choosing Truvada for HIV treatment. People living with HIV, whether newly diagnosed or long-term survivors, should have honest and direct conversations with their medical team about the best options about not only keeping their viral load suppressed, but also doing so without creating or worsening previous health conditions. It is often said that people living with HIV who stay on their meds consistently can enjoy the same life expectancy as those who are HIV negative.
We should also be considering the quality of that longer life expectancy, however, so that treating HIV effectively does not mean trading one long-term health issue for another. With Descovy representing a safer version of Truvada when it comes to bone and kidney health, clinical guidelines have already replaced Truvada with Descovy for many of their first-line ART recommendations, and clinicians are prescribing regimens that feature Descovy over Truvada as well.
If ART is doing its job and keeping HIV undetectable, the goal is now maintaining other aspects of health as well as possible moving forward. This requires being vigilant about your own and your family’s other health conditions so you can increase your chances of not having any potential medication side effects.
Pre-Exposure Prophylaxis (PrEP)
Beyond treatment, Truvada set itself apart from other HIV combination ART when it was approved by the FDA as an HIV prevention option in 2012. The landmark iPrEx and Partners PrEP studies demonstrated that people who were HIV negative and took Truvada consistently could reduce their risk of contracting HIV by 92% and 90%, respectively. When Truvada was approved for HIV prevention, it was a watershed moment for HIV clinicians, public health officials, and communities alike, ushering in the dawn of proven efficacy with biomedical HIV prevention options—and we haven’t looked back since.
As with HIV treatment, Truvada as PrEP is also a good combination medication for treatment of hepatitis B for someone who is not living with HIV. There have been reports, however, of patients experiencing an acute flare of hepatitis B (abdominal pain, liver swelling, nausea, and vomiting) when the medication is stopped suddenly. Care must be taken by those starting Truvada to remember that this could happen if it is stopped abruptly.
For those people taking Truvada as a part of HIV treatment, this may not be an issue, as there is incentive to continue medications for HIV viral suppression. For PrEP, however, when you are HIV negative and are taking Truvada as a preventive measure, the likelihood of stopping and starting is greater—so care is always advised if you are taking Truvada as HIV PrEP and you are also living with chronic active hepatitis B.
Using Truvada as an HIV prevention option has not been without controversy. To this day, you will still hear people calling those who take Truvada and acknowledge inconsistent condom use “Truvada whores” in an attempt to shame those who are honest about condomless sex and want to take control of their sexual health. This judgmental sentiment has been exhibited by both general community members and medical personnel alike.
Famously, Adam Zeboski, after being called a “Truvada whore,” created a T-shirt and movement that took control of the phrase that was intended to be disparaging, and instead made it a rallying cry for sexual empowerment. If you are taking Truvada for HIV prevention, don’t be ashamed or let other people shame you. You are simply being proactive in taking care of your sexual health.
Recently, social media was inundated with false advertising exaggerating the occurrence of kidney and bone disease in patients taking Truvada for PrEP, and only community action worked to get these false ads removed from various platforms. There have also been issues with communities and medical providers alike being opposed to offering biomedical HIV prevention options to patients, as they worry that behavioral approaches (such as using condoms) will be replaced by messaging to “just take a pill.”
Finally, for the years that Truvada was the only FDA-approved biomedical HIV prevention option for HIV-negative folk, there have always been concerns about cost, insurance coverage, access for communities who really need it, and perceptions of the drug’s maker, Gilead Sciences, Inc., being concerned more about profits than HIV prevention.
What’s the Verdict on Truvada?
After 16 years of Truvada being a part of both HIV treatment and prevention landscapes, it is important to recognize it as being one of the most influential and impactful ART medications in history. Not only was it one of the first combination medications and an early component of many of the first STRs, but it also was the first FDA-approved medication utilized for PrEP. Given the media attention and public concern about kidney and bone long-term side effects, no matter how safe studies have demonstrated it to be, it looks like Truvada’s best days as an HIV treatment option may be far behind it.
For both HIV treatment and prevention, the smaller and safer Descovy has replaced Truvada as the “go to” option for both patients and providers alike. As general acceptance and development of other methods of biomedical HIV prevention for HIV-negative persons increases, Truvada will go down in history as the blue pill that was the first to change public perception about going beyond behavioral approaches to embrace other forms of sexual health empowerment.
What does the future hold? Generic versions of Truvada weren’t expected until 2021. However, one generic competitor is being allowed to market its version at the end of September 2020. Other competitors are expected to follow in 2021, potentially resulting in increasingly affordable prices to help reach communities that so desperately need it. For countries, locations, and areas where resources are scarce and insurance companies refuse to put newer medications like Descovy on their preferred formularies, generic versions of Truvada will likely have a significant role in both HIV treatment and prevention. Although the concerns about side effects are real, the reality is that the vast majority of people who take Truvada do not experience these worrisome bone and kidney complications.
Finally, as we learn more about the side effect profile of Descovy, it is becoming more apparent that some people may actually be better candidates for Truvada for PrEP, while others are better candidates for Descovy. If cost is a major barrier for you, the medications included in Truvada can continue to be utilized in their generic forms once the patent expires, enjoying a shelf life as a part of HIV treatment and prevention for years to come.