Emtricitabine with tenofovir alafenamide

How it works

Both components are phosphorylated intracellularly and incorporated into viral DNA by reverse transcriptase, acting as chain terminators; tenofovir alafenamide delivers the active metabolite with lower plasma tenofovir exposure than the disoproxil prodrug.

Prescribing in practice

• Before use, HIV-negative status must be confirmed in the prophylaxis setting and hepatitis B status checked, as stopping therapy can cause severe hepatitis flares in co-infected patients.
• Tenofovir alafenamide has a more favourable renal and bone profile than tenofovir disoproxil but still requires caution at low levels of renal function.
• When used for prophylaxis it is one part of a combined prevention strategy and does not protect against other sexually transmitted infections.

Monitoring

Monitor HIV status, renal function and hepatitis B markers, with periodic testing during ongoing use.

Counselling the patient

• Take once daily and do not stop suddenly, especially if you have hepatitis B.
• For prevention, continue regular HIV testing and use condoms to guard against other infections.
• Attend follow-up appointments for kidney and infection monitoring.

Evidence & guidelines

Tenofovir alafenamide-based combinations are established in HIV treatment and prevention, supported by BHIVA and NICE recommendations.