There are currently two approved options for HIV pre-exposure prophylaxis (PrEP) in the US: emtricitabine/tenofovir disoproxil fumarate (Truvada®; F/TDF) and emtricitabine/tenofovir alafenamide (Descovy®; F/TAF).

F/TDF and F/TAF have differences in pharmacokinetics as well as renal and bone safety profiles.

Candidates for PrEP medication, who are at risk of HIV, often have additional risks of developing bone or renal comorbidities, due to a variety of factors, including race/ethnicity, diet, alcohol/substance use, tobacco smoking, concomitant medications, and/or other lifestyle factors.

Due to its more favorable safety profile, F/TAF may be the preferred choice for cisgender men and transgender women at risk of HIV, who are also at risk of developing bone or renal conditions; F/TDF may be the preferred choice in individuals at risk of HIV who are cisgender women or are at risk of HIV through receptive vaginal sex.

The more favorable safety profile of F/TAF is particularly advantageous during the ongoing global COVID-19 pandemic, as it may reduce the need for individuals to attend clinics in person.

Future PrEP options are warranted to allow for improved personalization to accommodate the various needs of individuals at risk of HIV.