Evaluating the combination of emtricitabine/ tenofovir alafenamide fumarate to reduce the risk of sexually acquired HIV-1-infection in at-risk adults

ABSTRACT

Introduction

Pre-exposure prophylaxis with a single daily pill of emtricitabine (F) plus tenofovir disoproxil fumarate (TDF) is highly efficacious at preventing HIV acquisition. Tenofovir alafenamide (TAF) is another tenofovir prodrug that delivers higher intracellular levels of active tenofovir diphosphate in blood cells and has an improved safety profile compared to TDF. Given the recent regulatory approval of the F/TAF combination for prophylaxis, it is important to review its safety and efficacy.

Areas covered

In this review, the author examines the safety and efficacy of F/TAF for pre-exposure prophylaxis. Both published manuscripts and conference papers are reviewed. F/TAF is non-inferior to F/TDF at preventing HIV acquisition in men and transgender women with a trend toward superiority. F/TAF has yet to be tested against HIV exposure via injection or vaginal intercourse.

Expert opinion

Within these limitations, F/TAF may be particularly advantageous for older individuals thanks to improved kidney safety compared to F/TDF. F/TAF did not possess the hypolipidemic properties of F/TDF and was associated with weight gains.

KEYWORDS:

• Emtricitabine
• tenofovir alafenamide
• HIV prevention
• pre-exposure prophylaxis
• antiretroviral drugs
• drug toxicity

Article highlights

• emtricitabine plus tenofovir disoproxil fumarate (F/TDF) prevents HIV transmission

• tenofovir alafenamide (TAF) yields higher intracellular drug concentrations than TDF

• F/TAF is non-inferior to F/TDF at preventing anal HIV acquisition

• F/TAF is safer for the bone and kidney than F/TDF

Declaration of interest

T Mesplede has received honoraria from Gilead Sciences Canada Inc., Merck Canada Inc., and ViiV Healthcare ULC outside of the submitted work. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript has not been funded.