Transitioning from Apretude to Descovy for PrEP

Transition Protocol

• The American Medical Association recommends beginning Descovy within 12 weeks after the last cabotegravir injection to maintain continuous HIV protection during the cabotegravir pharmacokinetic tail period 1, 4
• For optimal protection, the Centers for Disease Control and Prevention suggests starting Descovy before cabotegravir drug levels fall below protective thresholds 2, 3

HIV Testing Requirements

• The CDC recommends performing HIV testing (ideally antigen/antibody combination test AND HIV RNA test) before initiating Descovy to confirm HIV-negative status 5, 6
• The Morbidity and Mortality Weekly Report emphasizes that this testing is crucial as delayed seroconversion can occur with prior cabotegravir use 7

Monitoring During Transition

• The CDC suggests scheduling follow-up HIV testing at 4-6 weeks after starting Descovy 7
• The American Medical Association recommends continuing quarterly HIV testing after transition is complete 8, 9

Special Considerations

• The FDA notes that Descovy is particularly beneficial for patients with or at risk for renal dysfunction, osteopenia, or osteoporosis due to its improved renal and bone safety profiles compared to TDF-based regimens 8
• The CDC advises that for cisgender women, additional counseling about daily adherence is essential as pharmacokinetic data differs from injectable cabotegravir 5, 6

Adherence Support

• The American Medical Association suggests considering providing medication reminders or adherence tools to support the transition to daily oral PrEP 6

Common Pitfalls to Avoid

• The Morbidity and Mortality Weekly Report warns that inadequate HIV testing, including failure to perform comprehensive HIV testing (including RNA testing) before transition, could miss early HIV infection 7
• The CDC cautions that premature discontinuation of cabotegravir without overlap may leave patients vulnerable to HIV acquisition 3, 4