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Truvada
Truvada (generic name: emtricitabine and tenofovir disoproxil fumarate) is an antiviral medication used to treat HIV-1 infection and as pre-exposure prophylaxis (PrEP) to reduce the risk of HIV infection in high-risk individuals. It belongs to a class of drugs known as nucleoside reverse transcriptase inhibitors (NRTIs), which work by preventing HIV from multiplying in the body, thereby reducing the viral load and helping to prevent the virus from spreading. Truvada is commonly used in combination with other antiretroviral medications for the treatment of HIV.
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Frequently Asked Questions
How long does it take for Truvada to work for PrEP?
When taken daily, Truvada begins to provide protection against HIV after about 7 days for rectal exposure and about 20 days for vaginal exposure. It is important to continue taking it consistently to maintain protection.
Can I stop taking Truvada once I start?
If you are taking Truvada for HIV treatment, do not stop taking it without consulting your doctor, as this could lead to viral resistance. For PrEP, stopping should also be discussed with your healthcare provider, and you should continue testing for HIV.
Is Truvada safe for long-term use?
Truvada has been shown to be safe for long-term use, but regular monitoring of kidney function and bone health is recommended, especially in patients with risk factors for kidney or bone issues.
Can Truvada cure HIV?
No, Truvada cannot cure HIV. It helps manage the infection by reducing the viral load when used with other antiretroviral medications. In the case of PrEP, it helps prevent HIV infection in high-risk individuals.
Can I take Truvada if I have hepatitis B?
Yes, but you should be monitored closely. Stopping Truvada suddenly can cause a flare-up of hepatitis B. Always consult your doctor before making any changes to your treatment.
Comprehensive Drug Guide
How Does Truvada Work?
- Emtricitabine: A nucleoside reverse transcriptase inhibitor that interferes with the viral RNA-dependent DNA polymerase enzyme (reverse transcriptase), preventing HIV from multiplying.
- Tenofovir disoproxil fumarate: Another NRTI that blocks the same enzyme, helping to inhibit the replication of the virus.
Together, these drugs reduce the amount of HIV in the blood (viral load), help maintain a functioning immune system, and lower the risk of transmitting the virus to others.
Common Dosages
- 200 mg/300 mg tablet (200 mg emtricitabine / 300 mg tenofovir disoproxil fumarate)
Typical Dosing
- For HIV treatment: One tablet taken once daily, in combination with other antiretroviral medications.
- For PrEP (pre-exposure prophylaxis): One tablet taken once daily. Individuals must test negative for HIV before starting Truvada for PrEP and undergo regular HIV testing while taking it.
Typical Dosing
FDA Approved Indications
- Treatment of HIV-1 infection in combination with other antiretroviral agents
- Pre-exposure prophylaxis (PrEP) to reduce the risk of HIV-1 infection in high-risk individuals
Who Shouldn't Take Truvada?
- Known hypersensitivity to emtricitabine, tenofovir, or any component of the formulation
- HIV-positive individuals should not take Truvada for PrEP unless it is combined with other antiretrovirals, as it is not sufficient alone to treat HIV infection.
- Severe kidney impairment or end-stage renal disease requiring dialysis.
Advice From The Pharmacist
- Truvada should be taken exactly as prescribed, typically once daily with or without food.
- If you are taking Truvada for PrEP, it is crucial to have regular follow-ups with your healthcare provider for HIV testing and monitoring of kidney function.
- Missing doses of Truvada can increase the risk of developing drug resistance or, in the case of PrEP, reduce its effectiveness in preventing HIV infection.
- Store Truvada at room temperature and keep it in its original container to protect it from moisture.
Side Effects of Truvada
Common Side Effects
- Nausea
- Diarrhea
- Headache
- Dizziness
- Fatigue
Uncommon/Severe Side Effects
- Kidney problems, such as decreased kidney function or kidney failure
- Bone loss or reduced bone mineral density, which may lead to fractures
- Lactic acidosis, a rare but serious condition that involves a buildup of lactic acid in the blood
- Severe liver problems, including hepatomegaly (enlarged liver) and steatosis (fatty liver)
Risks and Warnings of Truvada
- Lactic Acidosis and Severe Hepatomegaly: Rare but serious side effects, particularly in patients with underlying liver disease. Symptoms include weakness, fatigue, unusual muscle pain, shortness of breath, and stomach pain. Seek medical attention immediately if these symptoms occur.
- Bone Health: Truvada can reduce bone mineral density, increasing the risk of fractures. Calcium and vitamin D supplementation may be recommended for some patients.
- Kidney Function: Truvada can cause kidney damage in some patients. Regular monitoring of kidney function is essential, especially in patients with pre-existing kidney conditions.
- Hepatitis B Reactivation: Patients co-infected with HIV and hepatitis B should be monitored closely, as discontinuation of Truvada may lead to a flare-up of hepatitis B infection.
Interactions with Truvada
Common Drug Interactions
- Other HIV medications: Combining Truvada with other NRTIs or antiretroviral medications is standard in HIV treatment. However, caution should be exercised when combining with other tenofovir-containing medications to avoid overdose.
- NSAIDs (e.g., ibuprofen): Long-term use of NSAIDs with Truvada may increase the risk of kidney problems.
- Antiviral drugs: Some antiviral drugs used for hepatitis B or C can interact with Truvada and affect how the drug works.
- Alcohol: Excessive alcohol use can increase the risk of liver and kidney damage while taking Truvada.
Alternatives to Truvada
- Descovy: A newer formulation that also contains emtricitabine but uses tenofovir alafenamide, which may be less likely to cause bone and kidney side effects.
- Atripla: A combination of emtricitabine, tenofovir, and efavirenz, used for the treatment of HIV.
- Complera: A combination drug used for the treatment of HIV, similar to Truvada but includes a different third agent (rilpivirine).
