On Jul. 8, 2020, Gilead Sciences announced data evaluating the impact of COVID-19 shelter-in-place orders (SIPOs) and PrEP utilization on HIV prevention strategies and associated risk behaviors. Findings included results from an online survey conducted by The American Academy of HIV Medicine (AAHIVM) to understand potential changes in behavior among pre-exposure prophylaxis (PrEP) users and prescribers in the U.S. during the height of COVID-19 SIPOs.

PrEP users reported modified sexual behavior associated with HIV risk during SIPOs, with 90 percent reporting no or fewer sexual partners, and no or fewer sex events. From the providers who completed the survey, 68 percent implemented telemedicine practices; 59 percent indicated refilling PrEP medications while postponing routine HIV/sexually transmitted infection (STI) and laboratory tests, to be completed as soon as possible; and 15 percent opted to completely forgo testing and lab monitoring. Of the 20 percent of responding providers who encountered PrEP users with suspected STIs for which they could not obtain a test, 47 percent treated STIs empirically.

PrEP is a guideline recommended HIV prevention strategy, but risk compensation could undermine potential benefits. Understanding sexual decision-making and how PrEP is incorporated into existing prevention strategies can help inform future PrEP implementation efforts. DISCOVER is an ongoing multi-center randomized controlled trial evaluating the safety and efficacy of Descovy (emtricitabine 200 mg/tenofovir alafenamide 25 mg) for PrEP^® in men and transgender women who have sex with men and are at risk for sexually acquired HIV infection. Data presented on study participant behavior in the DISCOVER trial found no longitudinal changes in the mean number of participants’ sex partners; condomless, insertive anal sex partners; or condomless, receptive anal sex partners from baseline through 96 weeks of follow-up. These findings suggest that an increase in risk behavior due to a reduction in perceived risk did not occur in the DISCOVER trial.

In the United States, Descovy for PrEP^® is indicated to reduce the risk of sexually acquired HIV-1 infection in at-risk adults and adolescents weighing at least 35 kg, excluding individuals at risk of HIV-1 from receptive vaginal sex, as effectiveness in this population has not been evaluated.

Descovy has a Boxed Warning in its U.S. product label regarding the risk of drug resistance when used for PrEP in undiagnosed early HIV infection, and the risk of post-treatment acute exacerbation of hepatitis B.