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.
Symtuza is a single-tablet, once-daily HIV treatment that combines four active ingredients: darunavir (a protease inhibitor), cobicistat (a booster), emtricitabine and tenofovir alafenamide (two NRTIs). It’s the only single-tablet regimen containing a boosted protease inhibitor, which gives it a high barrier to drug resistance.
Here’s what Symtuza offers and what to consider if it’s part of your treatment.
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What’s in Symtuza?
| Ingredient | Class | Role |
|---|---|---|
| Darunavir 800mg | Protease inhibitor | Blocks protease enzyme |
| Cobicistat 150mg | Pharmacokinetic booster | Keeps darunavir levels effective |
| Emtricitabine 200mg | NRTI | Blocks reverse transcription |
| Tenofovir alafenamide 10mg | NRTI | Blocks reverse transcription |
Who Can Take Symtuza?
- Adults starting HIV treatment for the first time
- People switching from another regimen with an undetectable viral load
- People who need a high-resistance-barrier regimen
- People with certain drug resistance profiles where integrase inhibitors aren’t suitable
How to Take Symtuza
Take one tablet once a day with food. Food is essential for proper absorption of darunavir.
Side Effects
- Diarrhoea (the most common side effect, from darunavir)
- Nausea
- Rash (usually mild)
- Headache
- Raised cholesterol
- Cobicistat raises creatinine slightly — this is not actual kidney damage but can look like it on blood tests
Drug Interactions
Because Symtuza contains cobicistat, it has significant interactions with many drugs. The same cautions as ritonavir-boosted regimens apply:
- Some statins are contraindicated
- Acid-reducing drugs are generally fine (unlike rilpivirine-containing regimens)
- Erectile dysfunction drugs need dose reduction
- Inhaled steroids can cause problems
- Always check with your HIV team before starting any new medicine
Advantages of Symtuza
- High barrier to resistance — good for people who may have adherence challenges
- Single-tablet convenience
- TAF version of tenofovir for better kidney and bone safety
- No restriction on acid-reducing medication (unlike rilpivirine-containing drugs)
Read more: Darunavir | Biktarvy | What is HIV?
Frequently Asked Questions
Is Symtuza better than Biktarvy?
Neither is inherently better — they suit different situations. Symtuza has a higher barrier to resistance thanks to the protease inhibitor, while Biktarvy has fewer drug interactions and side effects. Your HIV team will recommend the best option for your situation.
Why does Symtuza raise my creatinine?
Cobicistat blocks a kidney transporter that excretes creatinine. This raises the blood level without affecting actual kidney function. Your HIV team knows to interpret this correctly.
Can I take Symtuza in pregnancy?
Darunavir-based regimens are used in pregnancy. Discuss with your HIV specialist — they’ll weigh the specific benefits and monitoring needs.
Related reading
- Choosing the Right PrEP Drug: Truvada vs Descovy
- Dovato for HIV: A Two-Drug Regimen
- Triumeq for HIV: A Straightforward Guide
- Efavirenz for HIV: An Older NNRTI Still in Use
- Eviplera: How This Anti-HIV Drug Works
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.
