Prescribing Information
Women and HIV Risk
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Women and HIV Risk

Women and HIV Risk

INDICATION

TRUVADA FOR PrEP® (pre-exposure prophylaxis) is indicated to reduce the risk of sexually acquired HIV-1 in adults and adolescents (≥35 kg) who are at risk for HIV. HIV-1–negative status must be confirmed immediately prior to initiation

More women may be at risk for HIV than you think

Did you know?

1 in 5

new HIV diagnoses is in a woman1

The total number of women living with HIV in the US is increasing1

Each year, new diagnoses continue to add to the population of women living with HIV1


Most women at risk are not adequately protected from HIV

Condoms are underused

9 out of 10 women at risk for HIV reported having vaginal sex without a condom in the previous year2

Condom use is subject to negotiation between sexual partners—and when a woman has less power in a relationship, the couple may be less likely to use condoms consistently3

"Monogamy" does not always equal protection4-6

In two studies among couples who defined their relationships as monogamous4,5:

  • Self-reported infidelity occurred in up to 36% of couples
  • Despite infidelity, condoms were not used consistently

Women may be unaware of their partners' HIV risk factors7

Partner risk factors that can increase a woman's HIV risk include:

  • Concurrent sexual relationships/encounters
  • STI diagnoses
  • Other HIV risk factors (eg, a history of drug use or incarceration)
Learn about women's HIV risk by region

INDICATION

TRUVADA FOR PrEP® (pre-exposure prophylaxis) is indicated to reduce the risk of sexually acquired HIV-1 in adults and adolescents (≥35 kg) who are at risk for HIV. HIV-1–negative status must be confirmed immediately prior to initiation

IMPORTANT SAFETY INFORMATION

BOXED WARNING: RISK OF DRUG RESISTANCE WITH USE OF TRUVADA FOR PrEP IN UNDIAGNOSED EARLY HIV-1 INFECTION and POST TREATMENT ACUTE EXACERBATION OF HEPATITIS B

  • TRUVADA FOR PrEP must be prescribed only to patients confirmed to be HIV negative immediately prior to initiation and at least every 3 months during use. Drug-resistant HIV-1 variants have been identified with use of TRUVADA FOR PrEP following undetected acute HIV-1 infection. Do not initiate if signs or symptoms of acute HIV-1 infection are present unless HIV-negative status is confirmed
  • Severe acute exacerbations of hepatitis B virus (HBV) have been reported in patients who have HBV infection and discontinued TRUVADA. Hepatic function should be monitored closely with both clinical and laboratory follow-up for at least several months in patients with HBV after discontinuing TRUVADA. If appropriate, initiation of anti-hepatitis B therapy may be warranted

IMPORTANT SAFETY INFORMATION (cont'd)

Contraindication

  • TRUVADA FOR PrEP is contraindicated in patients with unknown or positive HIV status

Warnings and precautions

  • Comprehensive management to reduce risks:
    • Use TRUVADA FOR PrEP to reduce the risk of HIV-1 infection as part of a comprehensive strategy that includes adherence to daily dosing and safer sex practices, including condoms, to reduce the risk of sexually transmitted infections (STIs)
    • HIV-1 risk factors: Behavioral, biological, or epidemiologic HIV-1 risk factors may include, but are not limited to condomless sex, past or current STIs, self-identified HIV risk, having sexual partners of unknown HIV-1 viremic status, or sexual activity in a high-prevalence area or network
    • Reduce STI risk: Counsel on the use of STI prevention measures (e.g., consistent and correct condom use, knowledge of partner’s HIV-1 status, including viremic status, regular testing for STIs)
    • Reduce potential for drug resistance: Only prescribe TRUVADA FOR PrEP to patients confirmed to be HIV negative immediately prior to initiation, at least every 3 months while taking TRUVADA, and upon an STI diagnosis. HIV-1 resistance substitutions may emerge in patients with undetected HIV-1 infection who are taking only TRUVADA because TRUVADA alone is not a complete regimen for treating HIV-1
    • Some HIV tests may not detect acute HIV infection. Prior to initiating TRUVADA FOR PrEP, ask patients about potential recent exposure events. If recent (<1 month) exposures are reported or suspected, or symptoms of acute HIV infection (e.g., fever, fatigue, myalgia, skin rash) are present, confirm HIV-negative status with a test approved by the FDA for use in the diagnosis of acute HIV infection
    • If HIV-1 infection is suspected or if symptoms of acute infection are present while taking TRUVADA FOR PrEP, convert the TRUVADA FOR PrEP regimen to a complete HIV treatment regimen until HIV-negative status is confirmed by a test approved by the FDA for use in the diagnosis of acute HIV infection
    • Counsel on adherence: Counsel patients to strictly adhere to daily dosing, as efficacy is strongly correlated with adherence. Some patients, such as adolescents, may benefit from more frequent visits and counseling

Warnings and precautions

  • New onset or worsening renal impairment: Cases of acute renal impairment and Fanconi syndrome have been reported with the use of TDF. TRUVADA is not recommended in patients with estimated creatinine clearance (CrCl) <60 mL/min. Avoid concurrent or recent use with a nephrotoxic agent. Acute renal failure has been reported after initiation of high-dose or multiple NSAIDs in patients at risk for renal dysfunction; consider alternatives to NSAIDs in these patients. Monitor renal function in all patients (see Dosage and Administration section)
  • Bone effects: Decreases in bone mineral density (BMD) and mineralization defects, including osteomalacia associated with proximal renal tubulopathy, have been reported with the use of TDF. Consider monitoring BMD in patients with a history of pathologic fracture or risk factors for bone loss
  • Lactic acidosis and severe hepatomegaly with steatosis: Fatal cases have been reported with the use of nucleoside analogs, including TRUVADA. Discontinue use if clinical or laboratory findings suggestive of lactic acidosis or pronounced hepatotoxicity develop, including hepatomegaly and steatosis in the absence of marked transaminase elevations
  • Drug interactions: See Drug Interactions section. Consider the potential for drug interactions prior to and during use of TRUVADA, and monitor for adverse reactions

Adverse reactions

  • Common adverse reactions (>2% and more frequently than placebo) of TRUVADA FOR PrEP in clinical trials were headache, abdominal pain, and weight loss

Drug interactions

  • Prescribing information: Consult the full Prescribing Information for TRUVADA for more information, warnings, and potentially significant drug interactions, including clinical comments
  • Hepatitis C antivirals: Coadministration with ledipasvir/sofosbuvir, sofosbuvir/velpatasvir, or sofosbuvir/velpatasvir/voxilaprevir increases TDF exposure; monitor for adverse reactions
  • Drugs affecting renal function: Coadministration of TRUVADA with drugs that reduce renal function or compete for active tubular secretion may increase concentrations of emtricitabine and/or tenofovir

Pregnancy and lactation

  • Pregnancy: An Antiretroviral Pregnancy Registry (APR) has been established. Available data from observational studies and the APR show no significant difference in the rate of major birth defects for TRUVADA compared with a US reference population. Consider HIV prevention methods, including TRUVADA FOR PrEP in women due to the potential increased risk of HIV-1 infection during pregnancy and mother-to-child transmission during acute HIV-1 infection
  • Lactation: Emtricitabine and tenofovir have been detected in human milk. Evaluate the benefits and risks of TRUVADA FOR PrEP in breastfeeding women, including the risk of HIV-1 acquisition due to nonadherence, and subsequent mother to child transmission. Health benefits of breastfeeding should be considered along with potential adverse effects of TRUVADA on the child, which are unknown

Dosage and administration

  • Dosage: One tablet, once daily, with or without food
  • HIV screening: Test for HIV-1 infection prior to initiating and at least every 3 months during treatment
  • HBV screening: Test for HBV infection prior to or when initiating treatment
  • Renal impairment and monitoring: Not recommended in patients with CrCl <60 mL/min. Prior to or when initiating TRUVADA, and during use on a clinically appropriate schedule, assess serum creatinine, CrCl, urine glucose, and urine protein in all patients. In patients with chronic kidney disease, assess serum phosphorus

Please see full Prescribing Information for TRUVADA FOR PrEP, including BOXED WARNING.

References: 1. Centers for Disease Control and Prevention. HIV Surveillance Report, 2017; vol 29. Published November 2018. Accessed July 23, 2020. https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2017-vol-29.pdf 2. Centers for Disease Control and Prevention. HIV Infection, Risk, Prevention, and Testing Behaviors Among Heterosexuals at Increased Risk of HIV Infection–National HIV Behavioral Surveillance, 17 U.S. Cities, 2016. HIV Surveillance Special Report 19. Published April 2018. Accessed July 23, 2020. https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-number-19.pdf 3. Pulerwitz J, Amaro H, De Jong W, Gortmaker SL, Rudd R. Relationship power, condom use and HIV risk among women in the USA. AIDS Care. 2002;14(6):789-800. 4. Swan DJ, Thompson SC. Monogamy, the protective fallacy: sexual versus emotional exclusivity and the implication for sexual health risk. J Sex Res. 2016;53(1):64-73. 5. Warren JT, Harvey SM, Agnew CR. One love: explicit monogamy agreements among heterosexual young adult couples at increased risk of sexually transmitted infections. Department of Psychological Sciences Faculty Publications. 2010;60. 6. McMahon JM, Myers JE, Kurth AE, et al. Oral pre-exposure prophylaxis (PrEP) for prevention of HIV in serodiscordant heterosexual couples in the United States: opportunities and challenges. AIDS Patient Care STDS. 2014;28(9):462-474. 7. Chen YH, Raymond HF, McFarland W, Truong HM. HIV risk behaviors in heterosexual partnerships: female knowledge and male behavior. AIDS Behav. 2010;14(1):87-91.

Tap for Important Safety Information, including BOXED WARNING on the risk of drug resistance with TRUVADA FOR PrEP in undiagnosed early HIV-1 infection and post-treatment acute exacerbation of hepatitis B.