Truvada Missed Dose: What to Do?

Truvada is the PrEP super-drug, mainly because it’s the only fixed-dose combination regimen approved for the indication. The combination of tenofovir and emtricitabine is one of the mainstay treatments for human immunodeficiency virus and hepatitis B virus infection. It was later on approved for pre-exposure prophylaxis or PrEP to protect uninfected people from acquiring the virus through needle-stick injury, condomless sex with an HIV-positive partner, or sharing needles among injection drug users.1 The recommended dosage for Truvada is one pill taken orally once a day. Missing a dose is harmful because you need high doses of the medications in your system to fight HIV infection. However, recent studies showed that patients might still benefit from Truvada even when compliance is not 100%.

Goals of treatment

The goal of antiretroviral therapies (ART) is not to cure HIV but to increase your immune cells or CD4 count and decrease your viral load. Your CD4 T cells are depleted when you are infected by HIV. Viral load refers to the amount of virus particles in your bloodstream. On the other hand, the goal of PrEP is to protect your from infection; that’s why you need to take Truvada before viral exposure. Individuals, who are vulnerable to the disease, must test negative for HIV before they become eligible for PrEP. This is because the medications in Truvada are not enough to combat an existing infection, but it can successfully prevent you from contracting HIV as long as you are taking the meds prior to exposure. There is no cure for HIV. Once you get the virus, it will stay in your system indefinitely. But antiretroviral therapies can help you live longer if you take your meds properly and consistently.

What to do if you missed a dose of Truvada?

It is strongly recommended to take PrEP daily as it fosters the habit of consistent drug use and increases the drug levels in the blood, providing better protection from the disease. But there may be circumstances that prevent you from taking your meds, such as suffering from side effects (nausea or vomiting) or taking contraindicated drugs to treat another condition. In such cases, you need to consult your healthcare provider to know when and how to take Truvada. If you missed a dose, take it as soon as you remember it. If it’s almost time for the next dose, just take the scheduled dose and skip the missed dose. Do not double your dose to make up for the missed ones. You can take Truvada with or without food, even if you had an alcoholic beverage during the day. Do not abruptly stop treatment just because you’re experiencing side effects, especially if you have hepatitis B infection. Doing so can only worsen your HBV symptoms.

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 Effects of missing a dose

In earlier studies, taking Truvada for three days can provide up to 96% protection and 99% after five doses. Experts believe that high doses of drugs in the blood is an important factor in protecting a person from the virus. It was found that there were adequate levels of tenofovir and emtricitabine in the blood at least 2 hours after taking Truvada. However, in the Ipergay study, taking intermittent PrEP proved to be effective in preventing HIV for up to 86%. The study required taking two PrEP pills before sex and two pills after. Adherence in the study was good but not great. Among 81% of participants who answered the self-interview, less than 55% took all doses required.  Flexible dosing in Truvada can be beneficial in uninfected patients who do not want to take daily PrEP. But experts still recommend a daily dose of Truvada, as better adherence results in better protection. In the HPTN067 trial involving 179 South African women, those who adhere to their daily dose schedule had the highest levels of medication in their bloodstream. Furthermore, the participants generally prefer the regular dosing than intermittent because they don’t have to remember to take a pill before or after sex. In the initial phase, adherence was high and 93% of women who took daily Truvada showed adequate amount of drug in their bloodstream. At week 30, some of the subjects stopped taking treatment and the therapeutic levels in their blood dropped to 79%.