References UK clinical guidance from the NHS, the British HIV Association (BHIVA), and the British Association for Sexual Health and HIV (BASHH). Last updated: April 2026.
Two medications are approved for HIV PrEP: Truvada (emtricitabine plus tenofovir disoproxil fumarate, or TDF) and Descovy (emtricitabine plus tenofovir alafenamide, or TAF). Both are highly effective at preventing HIV, but they differ in their side effect profiles. In the UK, generic Truvada is the standard NHS PrEP option, while Descovy is available in some other countries.
Here’s how they compare.
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Key Differences
| Feature | Truvada (TDF/FTC) | Descovy (TAF/FTC) |
|---|---|---|
| Active ingredients | Emtricitabine + tenofovir DF | Emtricitabine + tenofovir alafenamide |
| HIV prevention | Over 99% | Over 99% (studied in MSM and trans women) |
| Kidney impact | Slightly more | Less |
| Bone density impact | Slightly more | Less |
| Weight | Less weight gain | Slightly more weight gain |
| Cholesterol | Better lipid profile | Slightly worse lipids |
| Approved for vaginal sex PrEP | Yes | Not yet (not studied in cisgender women) |
| Event-based (2-1-1) dosing | Validated for MSM | Not validated |
| UK NHS availability | Yes (standard) | Not routinely available |
| Generic versions | Widely available | Not yet |
Who Might Prefer Descovy?
- People with existing kidney problems or risk factors
- People with osteoporosis or bone density concerns
- MSM or trans women who want an alternative to TDF
Who Should Use Truvada?
- Anyone starting PrEP on the NHS (it’s the standard option)
- Cisgender women — Descovy hasn’t been studied for vaginal sex PrEP
- People who want event-based (2-1-1) dosing — only validated with Truvada
- People who prefer a drug with more long-term safety data
In the UK
Generic Truvada is the standard PrEP prescribed on the NHS. It’s well tolerated by the vast majority of users. Kidney function is monitored every 3-6 months, and problems are uncommon. If you develop kidney issues on Truvada, your clinic will discuss alternatives.
The Bottom Line
Both drugs are excellent at preventing HIV. The choice mostly comes down to kidney and bone considerations, availability and whether you need protection for vaginal sex. For most people in the UK, generic Truvada is the right choice.
Read more: PrEP benefits and risks | How to get PrEP in the UK | What is HIV?
Frequently Asked Questions
Can I get Descovy on the NHS?
Not routinely. Generic Truvada is the standard NHS PrEP. If you have specific kidney concerns, discuss with your clinic.
Is Descovy better than Truvada?
Neither is clearly “better.” Descovy is gentler on kidneys and bones; Truvada has broader evidence including for vaginal sex and on-demand dosing. Choose based on your individual needs.
Can women use Descovy for PrEP?
Descovy hasn’t been studied in cisgender women for PrEP. Truvada remains the recommended option for anyone needing protection during vaginal sex.
Related reading
- PrEP Benefits, Truvada Side Effects and Risks
- Are HIV Tests Accurate If You're on PrEP, PEP or ART?
- Dovato for HIV: A Two-Drug Regimen
- Triumeq for HIV: A Straightforward Guide
- Efavirenz for HIV: An Older NNRTI Still in Use
Sources
- NHS — Sexual health conditions
- BASHH — UK clinical guidelines for STI management
- British HIV Association (BHIVA) — HIV treatment guidelines
- Terrence Higgins Trust — sexual health information
- UK Health Security Agency — STI surveillance data
Steve Page is a recognised expert on Sexually Transmitted Diseases (STDs) and STD treatments, having published numerous articles in peer-reviewed journals and presented his research at conferences around the world. He has an in-depth understanding of the latest medical research on STDs, and is an advocate for the development of new treatments and protocols to improve the health of those affected. In addition to his research, he has dedicated his career to understanding the causes and symptoms of STDs, as well as how to best treat those impacted.
