You may have heard by now there’s another medication coming out soon that can be used for HIV Pre-Exposure Prophylaxis (PrEP). This medication is called Descovy and is actually an updated formulation of the medication currently used for PrEP, Truvada. The two drugs both contain Emtricitabine and Tenofovir, with Descovy containing the safer version, Tenofovir alefenamide.
Why the reason for the change?
Truvada is known to cause kidney dysfunction and decreased bone density in a very small percent of the population who takes it. This is why it’s important for patients on Truvada to have routine monitoring. With Descovy, there are no renal or bone density effects.
The 94 week clinical trial that studied the efficacy of Descovy vs Truvada found that Descovy is non-inferior to Truvada. In medical terms, Descovy was not worse than Truvada for PrEP. In other words, Descovy works just as good as Truvada.
Switching from Truvada to Descovy should be a no-brainer right?
This switch should be made in patients who have experienced renal or bone issues on Truvada, but what about others who have done just fine on Truvada?
Well, that’s where the discussion gets a little more complicated. Generic Truvada will come available in the U.S. sometime in 2020. Switching patients from Truvada to Descovy will likely result in higher costs as Gilead will have a patent on Descovy for the foreseeable future.
Wendy Armstrong, Infectious disease specialist and professor at Emory University School of Medicine here in Atlanta, thinks “the big picture here is that we have an out-of-control HIV epidemic, and as much as I hate to think about cost as a physician, I think we have to. When I look at the small clinical difference that may or may not be significant in bone and renal health for a drug that’s not taken every day for the rest of their lives, I don’t know that that’s important.”
Is there still a place for Truvada?
The truth is that Truvada has been and will continue to be a very effective tool for combatting new HIV infections. One of the main barriers for patients going on PrEP has been access to care and, for many patients, cost. While many insured patients are able to obtain the drug for zero dollars out-of-pocket in many cases, uninsured patients often find the cost of the drug leaves it out-of-reach. Despite the Ryan White program and programs like Gilead’s Advancing Access, there are still many at-risk individuals who are not on Truvada.
When Truvada goes generic and the cost of the drug dramatically decreases, the hope is that this will help bridge the gap for patients who have been left behind. Moreover, Descovy will also give medical providers more options to prescribe PrEP for those with renal issues or those who had kidney or bone density issues while taking Truvada.
If you feel you are at-risk for HIV, speak with your medical provider to discuss PrEP and other ways to lower your risk of HIV or STI infection. If you are HIV positive, make an appointment with one of our HIV specialists to ensure you’re on the most appropriate medication regimen.
Jeremiah Robinson is a licensed and certified Physician Assistant at T. Douglas Gurley MD in Atlanta, GA.