Emtricitabine/tenofovir alafenamide (as fumarate) (Descovy^®) is recommended an option for restricted use within NHS Wales for pre-exposure prophylaxis (PrEP) to reduce the risk of sexually acquired HIV-1 infection in at-risk men who have sex with men, including adolescents (with body weight at least 35 kg).

Descovy^® is restricted as a second line option for a subpopulation of people who are eligible for PrEP but are intolerant of, or have contraindications to, emtricitabine/tenofovir disoproxil (FTC/TD). This should be when an individual cannot take the usual first-line PrEP therapy due to risk factors to FTC/TD use. Risk factors for the use of FTC/TD are:

• a reduction in estimated glomerular filtration rate (eGFR < 60 ml/min) and clinical assessment suggests that Descovy® would have a lower risk profile than FTC/TD, or;
• proven renal toxicity with FTC/TD (acute or chronic), or;
• osteoporosis and high risk for fractures, or;
• an eGFR ≥ 60 ml/min where: a progressive reduction in glomerular filtration rate on FTC/TD is seen (reduction in eGFR of 15 ml/min in the past 12 months or 25% reduction in eGFR in the past 12 months) and there are significant concurrent medical issues or monitoring/prescribing concerns which suggest Descovy^® would have a lower risk profile compared to FTC/TD, or;
• adolescents who are < 18 years.