Truvada vs. Descovy for PrEP

Condoms, abstinence (not having sex), and not sharing needles are all strategies you can use for HIV prevention. There’s also the option of HIV prevention medications called PrEP (pre-exposure prophylaxis). 

Currently, there are two FDA-approved PrEP options: Truvada and Descovy. While both medications are effective at preventing HIV infection and contain similar ingredients, they’re not interchangeable. 

Read on to learn about the key differences and similarities you should know about Truvada and Descovy.

What is PrEP?

Simply put, PrEP allows people who don’t have HIV to take medication to prevent getting an HIV infection. These medications include Truvada (emtricitabine/tenofovir disoproxil fumarate) and Descovy (emtricitabine/tenofovir alafenamide).

Certain body fluids can spread HIV from person to person. These include blood, breast milk, semen, as well as vaginal and rectal fluids. PrEP medications can prevent you from getting HIV if you’re exposed to one of these fluids that contain HIV. Most of the time, this exposure happens during sexual intercourse or while sharing injection supplies.

It’s important to note that PrEP doesn’t protect against other sexually transmitted infections (STIs) or pregnancy. It’s meant to be used with safer sex practices (like condoms) to lower your STI risk and birth control, if you’re trying to prevent pregnancy.

PrEP is also different from post-exposure prophylaxis (PEP). The recommended PEP regimen usually includes Truvada in combination with another medication — either raltegravir or dolutegravir. A full PrEP regimen is Truvada (or Descovy) alone. 

Although both PrEP and PEP are used to prevent HIV infection in an uninfected person, PrEP is taken before potential exposure, and PEP is taken within 72 hours after potential exposure. 

How does PrEP work?

Antiretrovirals (ARVs) — medications like Truvada and Descovy that work against HIV — are used for PrEP. But Truvada and Descovy alone can’t treat HIV; they can only prevent it. Confusing, we know.

When treating an HIV infection, providers use a combination of ARVs to more effectively lower the amount of virus in the body. A complete HIV regimen usually contains two or more ARVs from at least two different ARV medication classes. Each class works differently against the virus. Using medications that attack the virus with different mechanisms (strategies) helps prevent HIV from becoming resistant to medication.

Truvada and Descovy contain two ARVs, but they’re from the same medication class — nucleoside reverse transcriptase inhibitors (NRTIs). NRTIs work by stopping HIV from replicating (making copies of itself) in the body. 

While Truvada or Descovy aren’t a complete HIV treatment regimen for people who have HIV, they’re very good at preventing infection in people who don’t have HIV. This is why they’re used for PrEP.

When you take PrEP medications, your body builds up medication levels in your tissues so you’re ready to fight the virus as soon as you’re exposed. This fast action prevents HIV from entering your CD4 T cells — immune system cells that HIV infects and uses to make copies of itself. 

PrEP is typically taken every day to build up enough medication in your body. However, the Centers for Disease Control and Prevention (CDC) may be adding “on-demand” PrEP for certain people — taking it only when you’re at risk — to their updated PrEP guidelines in the near future. More on that later.

Who should take PrEP?

The CDC provides the following guidance on who might be a good candidate for PrEP, including people who:

• Inject drugs and share injection equipment

• Have a sexual partner who has HIV — especially if they aren’t on treatment or have a detectable viral load (amount of virus in the body)

• Have been prescribed PEP (especially multiple courses) and continue behaviors that put them at risk for infection

• Had a recent STI (in the last 6 months)

• Don’t always use condoms

• Work in the commercial sex industry

Talk to your healthcare provider to see if PrEP is right for you.

Who shouldn’t take PrEP?

While PrEP is an excellent tool for HIV prevention, it’s not for everyone. 

People currently living with HIV shouldn’t take PrEP. As mentioned above, Truvada and Descovy aren’t complete HIV treatment regimens alone. If someone with HIV takes a partial (incomplete) regimen, the virus could become resistant to the medication, leading to potential health complications. 

This is why you’ll need to take an HIV test before starting PrEP, and every 3 months after, in order to get prescription refills.

Tenofovir — one of the ARVs in Truvada and Descovy — can damage the kidneys. Descovy contains a newer version of tenofovir, which is safer for the kidneys (more on that later). Still, Descovy and Truvada for PrEP may not be appropriate for people with severe kidney problems. 

Lastly, PrEP is approved for adults and adolescents who weigh at least 75 lbs. At this time, PrEP isn’t an option for adolescents under the age of 18 who weigh less than 75 lbs. 

How do Truvada and Descovy compare for PrEP?

Truvada and Descovy both contain emtricitabine and tenofovir, and both are FDA-approved for PrEP. The two medications are very similar to each other, yet there are subtle differences. 

Descovy is a newer medication, and it contains a different form of tenofovir. Truvada has been around for longer, so there’s more research regarding its use for PrEP. 

Both medications are effective options for PrEP, but one may be better suited for certain individuals. Here we’ll take a look at the differences between the medications.

Is one more effective than the other?

Truvada and Descovy are both about 99% effective at preventing HIV infections from sexual exposure.

PrEP isn’t as effective at preventing HIV infections from injection drug use, which might be due to poor medication adherence. This number is closer to 74%. At this time, only Truvada is recommended for people who are at risk for HIV from injection drug use. Descovy hasn’t been studied in this population yet.

Which medication is safest?

Overall, both medications are safe and effective at preventing HIV in people who don’t have HIV and are at risk of infection.

However, both medications have a boxed warning — the FDA’s most serious warning — about potential medication resistance when used for PrEP in people with an undiagnosed, early HIV infection. While testing is important, some HIV tests may not pick up on an early infection, since they only test for antibodies (proteins made by your immune system). If you may have been recently exposed to the virus or have HIV symptoms, your provider may have you take a test that can detect an early infection.

There’s also a boxed warning about worsening hepatitis B infections after Truvada or Descovy are discontinued. If you have hepatitis B, your provider should be monitoring your liver for several months after you stop taking either medication.

As mentioned earlier, Descovy contains a form of tenofovir with a different chemical structure than Truvada. Tenofovir alafenamide (TAF) — the tenofovir found in Descovy — is safer for kidney and bone health. In terms of safety, Descovy may be a better option for people at high risk for kidney problems and osteoporosis. 

Are there differences in who can use Truvada and Descovy for PrEP?

Some people think of Descovy as “Truvada 2.0,” since it’s the newer version of an emtricitabine and tenofovir combination tablet. However, Descovy isn’t exactly the same as Truvada, and some people shouldn’t use Descovy for PrEP. 

As mentioned above, Truvada is the only medication recommended as PrEP for people at risk for HIV due to injection drug use. This is because Descovy for PrEP hasn’t been studied in that patient population yet. 

Likewise, Descovy isn’t approved for PrEP in people at risk for getting HIV through receptive vaginal sex. However, Gilead — the company that makes Truvada and Descovy — reports that they’re studying it.

What about on-demand PrEP?

On-demand PrEP, also referred to as non-daily PrEP or Truvada 2-1-1, is an alternative PrEP dosing schedule that can lower the risk of HIV in men who have sex with men. With on-demand PrEP, you take 2 pills of Truvada 2 to 24 hours before sex, then 1 pill 24 hours later, and 1 pill 24 hours again after that. On-demand PrEP can be a good option for certain people who don’t like to take medication every day.

Right now, Truvada is the only medication that has been studied for on-demand PrEP. At the time of this article, the CDC doesn’t formally recommend on-demand PrEP. However, we expect to see guidance on this with the updated PrEP guidelines in the near future.

How to save on Truvada and Descovy

Truvada and Descovy are available as brand-name medications. But you can also find Truvada as a lower-cost generic. GoodRx can help you navigate ways to save on your prescription.

• Save with GoodRx. GoodRx can help you save over 98% off the average retail price of generic Truvada. Generic Truvada’s price at certain pharmacies is less than $31 with a free GoodRx discount.

• Save with patient assistance programs. If you’re uninsured or underinsured, you may be eligible for Truvada or Descovy patient assistance programs, which offer the medication at no charge.

• Save with a copay savings card. If you have commercial insurance and meet eligibility requirements, Truvada’s price is as little as $0 if you use the manufacturer’s savings card. Descovy’s price may be less than $5 if you use the manufacturer’s savings card.

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Written by:

Hope Chang, PharmD, AAHIVP

Hope Chang is a freelance writer and content reviewer for GoodRx. She attended Howard University College of Pharmacy in Washington, D.C. and completed post-graduate residency training at the University of California, Davis Medical Center.

Edited by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

Reviewed by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

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