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Drug vs. Drug

Descovy vs. Truvada: Differences, similarities, and which is better for you

Gerardo Sison medical writer headshot By | May 11, 2020

Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ

Among the many different types of HIV medications out there, Descovy (emtricitabine/tenofovir alafenamide) and Truvada (emtricitabine/tenofovir disoproxil fumarate ) are two antiretroviral agents that are commonly prescribed. For many years, Truvada was the only FDA-approved drug for pre-exposure prophylaxis (PrEP), or prevention of HIV. However, in October 2019, Descovy also received FDA approval for PrEP.

Both drugs are manufactured by Gilead Sciences, Inc. and work in similar ways as nucleoside reverse transcriptase inhibitors (NRTIs). In order for HIV to replicate, it needs to create DNA from building blocks called nucleotides. Truvada and Descovy block the reverse transcriptase (RT) enzyme, which uses nucleotides to convert RNA to DNA. In this way, these drugs help prevent the formation of new viruses.

Although both drugs contain almost identical components, they have some differences in adverse effects, dosage, and indications.

What are the main differences between Descovy and Truvada?

Descovy

Descovy is the brand name for the combination of emtricitabine (FTC) and tenofovir alafenamide (TAF). It was initially approved in 2015 to treat adults and children with HIV-1 infection.

TAF in Descovy has higher plasma stability compared to TDF in Truvada. As a result, TAF is more potent with higher concentrations in HIV-infected cells. Descovy tablets contain 200 mg of FTC and 25 mg of TAF.

Truvada

Truvada is the brand name for emtricitabine (FTC) and tenofovir disoproxil fumarate (TDF). The combination of these drugs was FDA-approved in 2004 for HIV treatment.

Compared to Descovy, Truvada has been shown to have more adverse effects on kidney function and bone density. It also comes in higher strengths of the tenofovir prodrug TDF: 300 mg, 250 mg, 200 mg, and 100 mg.

Main differences between Descovy and Truvada
Descovy Truvada
Drug class Antiretroviral drug
Nucleoside reverse transcriptase inhibitor (NRTI)
Antiretroviral drug
Nucleoside reverse transcriptase inhibitor (NRTI)
Brand/generic status No generic version available Generic version has been approved, but is not yet commercially available
What is the generic name? Emtricitabine/Tenofovir alafenamide Emtricitabine/Tenofovir disoproxil fumarate
What form(s) does the drug come in? Oral tablet Oral tablet
What is the standard dosage? HIV treatment: 200 mg FTC/25 mg TAF tablet once daily with or without food

PrEP: 200 mg FTC/25 mg TAF tablet once daily with or without food

HIV treatment: 200 mg FTC/300 mg TDF tablet once daily with or without food

PrEP: 200 mg FTC/300 mg TDF tablet once daily with or without food

How long is the typical treatment? There is no cure for HIV infection or AIDS. Antiretroviral treatment must be taken consistently every day to control the virus.
Who typically uses the medication? HIV treatment: Adults and children aged 12 years and older who weigh at least 55 lbs

PrEP: Adults and children aged 12 years and older who weigh at least 75 lbs

HIV treatment: Adults and children aged 12 years and older who weigh at least 35 lbs

PrEP: Adults and children aged 12 years and older who weigh at least 75 lbs 

Conditions treated by Descovy and Truvada

Descovy and Truvada are indicated to treat HIV infection in combination with other drugs. When used as HIV treatment, Descovy or Truvada is often used along with an integrase inhibitor like Tivicay (dolutegravir) or a protease inhibitor like Prezista (darunavir). Descovy or Truvada can also be used with a non-nucleoside reverse transcriptase inhibitor (NNRTI) like Sustiva (efavirenz).

Both Descovy and Truvada can be used for HIV prevention, otherwise known as pre-exposure prophylaxis (PrEP). For those who are at risk of HIV, Descovy or Truvada can be taken once daily to prevent HIV infection. Those who may be at risk of HIV include sexually active adults and adolescents as well as IV (intravenous) drug users.

Because its data for PrEP approval did not include cisgender women, Descovy is not approved for use in those at risk from vaginal sex. Descovy has been studied for PrEP in trans women and men who have sex with men. Truvada has been studied for PrEP in these same populations plus IV drug users and heterosexual couples.

Condition Descovy Truvada
HIV Infection Yes Yes
HIV Prevention (PrEP) Yes Yes

Is Descovy or Truvada more effective?

Both Descovy and Truvada have been shown to be effective in treating and preventing HIV infections. However, as a newer drug, Descovy is marketed by Gilead Sciences as a safer and more effective option. The main argument for Descovy lies in the drug’s higher concentration in HIV-infected cells with minimal repercussions on kidney and bone health.

Several clinical trials have shown that TAF is non-inferior to TDF for treating HIV infection. Meaning, TAF is just as effective as TDF. The Discover Trial is an active trial evaluating the safety and efficacy of Descovy versus Truvada for PrEP. Results from the trial, which included 5,387 participants, showed that Descovy was similarly effective to Truvada with significant improvements in kidney function and bone mineral density.

However, many doctors and their colleagues are hesitant to recommend Descovy as a first-line option for PrEP. According to Dr. Krakower, a leading doctor and an assistant professor at Harvard Medical School, improvements in safety profile may not be as clinically significant as Gilead says. Some studies have shown that TAF in Descovy may also contribute to weight gain in some patients.

Despite their proven efficacy and safety, both Descovy and Truvada only work when they’re taken consistently every day. Without proper adherence to the medication, the risk for HIV resistance increases. It’s important to discuss available HIV drugs with a healthcare provider to determine the best treatment option.

Coverage and cost comparison of Descovy vs. Truvada

Descovy and Truvada come at a hefty price. The average retail cost for either drug is more than $2,000. Fortunately, these drugs are usually covered by Medicare and insurance plans. For those without insurance, assistance programs are available to help offset the costs. Gilead, the manufacturer of these drugs, offers its own

  Descovy Truvada
Typically covered by insurance? Yes Yes
Typically covered by Medicare? Yes Yes
Standard dosage One tablet (200 mg FTC/25 mg TAF) daily One tablet (200 mg FTC/300 mg TDF) daily
Typical Medicare copay $42–$1,807 $42–$1,827
SingleCare cost $1,821+ $1,871+

Common side effects of Descovy vs. Truvada

The most common side effects of Descovy include nausea, diarrhea, and fatigue. Other side effects include stomach ache or abdominal pain as well as headaches. Truvada can also cause similar side effects.

According to the Discover Trial, those taking Truvada experienced more diarrhea, nausea, fatigue, and abdominal pain compared to those taking Descovy. These differences in side effects, however, may not be large enough to make a meaningful impact on treatment.

More serious side effects of Descovy and Truvada may include rash or other signs of an allergic reaction. These drugs also have the potential to cause impaired kidney function and reduced bone mineral density.

  Descovy Truvada
Side effect Applicable? Frequency Applicable? Frequency
Diarrhea Yes 5% Yes 6%
Nausea Yes 4% Yes 5%
Fatigue Yes 2% Yes 3%
Abdominal pain Yes 2% Yes 3%
Headache Yes 2% Yes 2%

This may not be a complete list of adverse effects that can occur. Please refer to your doctor or healthcare provider to learn more.
Source: DailyMed (Descovy), DailyMed (Truvada)

Drug interactions of Descovy vs. Truvada

Descovy can interact with protease inhibitors (PIs), anticonvulsants, antimycobacterial agents, and herbal products. An antiretroviral PI such as tipranavir can decrease the level and effectiveness of Descovy. Anticonvulsants, antimycobacterials, and certain herbal drugs like St. John’s Wort can also decrease the effectiveness of Descovy.

Truvada can interact with protease inhibitors like lopinavir, atazanavir, and darunavir. Taking these drugs with Truvada can increase tenofovir levels, causing increased adverse effects. Truvada can also interact with didanosine and increase its concentrations. Increased didanosine levels may lead to increased adverse effects like pancreatitis and neuropathy.

Both Descovy and Truvada can interact with antiviral drugs used to treat Hepatitis C. Drugs like Harvoni (ledipasvir/sofosbuvir) can affect Descovy or Truvada levels. Altered drug levels could result in decreased effectiveness or increased side effects.

Drug Drug Class Descovy Truvada
Atazanavir
Ritonavir
Darunavir
Tipranavir
Protease inhibitors (PIs) Yes Yes
Sofosbuvir/velpatasvir
Sofosbuvir/velpatasvir/voxilaprevir
Ledipasvir/sofosbuvir
Hepatitis C antivirals Yes Yes
Carbamazepine
Oxcarbazepine
Phenytoin
Anticonvulsants Yes No
Rifampin
Rifabutin
Antimycobacterial agents Yes No
St. John’s Wort Herbals Yes No
Didanosine Nucleoside reverse transcriptase inhibitor (NRTI) No Yes

*Consult a healthcare professional for other drug interactions

Warnings of Descovy and Truvada

Individuals who discontinue Descovy or Truvada may experience worsened hepatitis B virus (HBV) infection. Liver function should be monitored in individuals with an HBV infection after discontinuing Descovy or Truvada. Hepatitis B treatment may also be warranted in these cases.

Because tenofovir is primarily eliminated through the kidneys, Descovy and Truvada can worsen renal function. Descovy and Truvada can also impact bone mineral density (BMD). Those with a history of kidney disease or osteoporosis should be monitored when using Descovy or Truvada.

Descovy and Truvada should only be used for PrEP in individuals who are confirmed HIV-negative. It is important to get tested for HIV periodically while taking Descovy or Truvada. Otherwise, there is a risk of contracting drug-resistant HIV, which can be harder to treat.

Talk to a healthcare provider to learn about risks for other possible adverse effects. Your medical history and other medications you take can also affect how you respond to Descovy or Truvada.

Frequently asked questions about Descovy vs. Truvada

What is Descovy?

Descovy is a once-daily pill used to treat HIV infection. It is also used for HIV pre-exposure prophylaxis (PrEP) in those at risk. Descovy contains a combination of emtricitabine (FTC) and tenofovir alafenamide (TAF).

What is Truvada?

Truvada is an antiretroviral medication used to treat HIV infection. It is commonly prescribed as a once-daily tablet for HIV PrEP in those at risk of HIV. Truvada contains a combination of emtricitabine (FTC) and tenofovir disoproxil fumarate (TDF).

Are Descovy and Truvada the same?

Descovy and Truvada are both manufactured by Gilead Sciences. However, they are not the same drug. Descovy is a newer drug that contains tenofovir alafenamide (TAF). Truvada contains tenofovir disoproxil fumarate (TDF).

Is Descovy or Truvada better?

Descovy and Truvada are both effective drugs for HIV treatment and PrEP. Descovy does not impair kidney function or decrease bone density as much as Truvada. However, Truvada is an older drug with more data to support its use in some cases. It’s important to discuss these options with a doctor to determine the best treatment for you.

Can I use Descovy or Truvada while pregnant?

There is no evidence to suggest that Descovy or Truvada is harmful to the unborn baby. PrEP medications may be safe and tolerated during pregnancy. However, these drugs should only be used if the benefits outweigh the risks. Consult a doctor if you are pregnant and currently taking or considering an antiretroviral drug.

Can I use Descovy or Truvada with alcohol?

It is not recommended to consume alcohol while taking Descovy or Truvada. Doing so could increase the adverse effects of these drugs such as nausea and headache. Alcohol abuse and dependence are also associated with increased risky behavior which could lead to a higher HIV risk.

Should I switch from Truvada to Descovy?

Descovy has been shown to be a safe and effective PrEP alternative to Truvada in certain people. However, a switch from Truvada to Descovy is at the discretion of your doctor and their clinical judgment.

Is Descovy approved for PrEP?

Descovy was approved for PrEP in the latter part of 2019. It is FDA approved for HIV prevention in those at risk of HIV, except for those who are at risk from vaginal sex. Descovy was studied for PrEP in gay and bisexual men as well as transgender women.

Is Truvada bad for kidneys?

Using Truvada may lead to impaired kidney function, especially in those who are susceptible to kidney damage. Truvada should be avoided while taking nephrotoxic drugs like NSAIDs which could potentially damage the kidneys. Your doctor may test your kidney function before starting Truvada.