Studies have shown Descovy can lead to a modest weight gain with studies showing an increase of:

• 1.7 kg to 2.43 kg (3.7 to 5.4 lbs) in the initial 9 to 18 months on therapy in people living with HIV
• 0.83 kg to 1.1 kg (1.8 to 2.4 lbs) per year when used for pre-exposure prophylaxis (PrEP), including people who switched from Truvada to Descovy.

Descovy weight gain may be greater in people living with HIV and being treated with tenofovir alafenamide (TAF) - a component of Descovy - as compared to people taking Descovy for PrEP.

In general, antiretroviral HIV treatment may also cause weight gain due to:

• positive health outcomes
• changes in your metabolism
• use with other medicines
• individual patient characteristics.

In some patients, the reason why weight gain occurs is not fully known or may be due to general patterns of weight gain seen in the average population.

Learn more: Why else may I gain weight with ART?

What are Descovy and Truvada?

Descovy and Truvada are both oral tablets used to treat or help prevent HIV infection (for PrEP). Both medicines contain the antivirals emtricitabine and tenofovir and are taken as an oral tablet once daily. HIV-1 is the virus that causes Acquired Immune Deficiency Syndrome (AIDS).

If used daily as directed, both medicines are over 99% effective at preventing HIV infection from sex. But there is a difference between these drugs - Descovy contains a newer form of tenofovir called tenofovir alafenamide (TAF), while Truvada contains an older formulation called tenofovir disoproxil fumarate (TDF).

These differences may affect the types of side effects you might experience. While Descovy (emtricitabine + tenofovir alafenamide, or TAF) has a more favorable kidney and bone safety profile than Truvada (emtricitabine + tenofovir disoproxil fumarate, or TDF), concerns about weight gain and changes in lipid profiles exist for TAF.

Uses

Descovy is approved by the FDA:

HIV treatment

• To treat HIV-1 infection in combination with other anti-HIV-1 medicines in adults and children who weigh at least 35 kg (77 lb)
• To treat HIV-1 infection in combination with other anti-HIV-1 medicines other than protease inhibitors that require a CYP3A inhibitor in children weighing at least 14 kg (30.8 lb) and less than 35 kg (77 lb).

HIV-1 PrEP

• For HIV-1 PrEP in at-risk adults and adolescents who weigh at least 77 pounds (35 kg) to reduce the risk of getting HIV-1 infection.
• Descovy for PrEP is not for use in people born female (assigned female at birth) who are at risk of getting HIV-1 infection from receptive vaginal sex, because its effectiveness has not been studied in this group.
• A negative HIV-1 test is required immediately before initiating treatment.

Truvada is approved by the FDA:

• To treat HIV-1 infection with other anti-HIV-1 medicines in adults and children who weigh at least 37 pounds (17 kg).
• For HIV-1 PrEP to reduce the risk of getting HIV-1 infection in adults and adolescents who weigh at least 77 pounds (35 kg).

Does Descovy make you gain weight?

Weight Gain in HIV Treatment

Descovy weight gain is not reported as a side effect in the manufacturer's package labeling for Descovy, but some studies have shown this effect.

A study from involving 6908 people living with HIV showed weight gain after switching from Truvada to Descovy.

• Weight gain in the first 9 months after switching to TAF for those that maintained all other ARVs was 2.43 kg (5.4 lbs) and then stabilized back to an average of 0.24 kg (0.5 lb) per year after the first 9 months.
• This increase occurred within the first 9 months after switching to TAF and slowed to rates similar to those seen prior to switch or leveled off thereafter.
• The average adjusted weight gained was 1.5 kg after 12 months and 1.9 kg after 24 months on TAF.

Another study was done in over 4,375 people living with HIV who had received anti-retroviral treatment for HIV that contained TDF for 6 months or longer. In the study, about 80% of people switched to TAF, while 20% stayed on TDF.

• After 18 months, researchers found that switching from TDF to TAF was associated with a mean increase in weight of 1.7 kg (3.7 lb) compared to 0.7 kg (1.5 lb) with TDF.
• In addition, in people who had a normal body-mass index (BMI) at the start of the study, 13.8% who switched to TAF fell into the overweight/obese category compared to 8.4% who stayed on TDF 18 months later.

Weight Change in PrEP (iPrEx and DISCOVER Study)

The 2010 iPrEX clinical trial was a randomized, double-blind, placebo-controlled Phase 3 study with 2,499 participants evaluating the efficacy and safety of Truvada compared with placebo. In the metabolic subcohort:

• Median weight change at Week 48 in people taking Truvada was a loss of 0.3 kg (0.66 lb).
• Median weight change at Week 48 in people taking placebo (an inactive pill) was a gain of 0.5 kg (1.1 lb).

The DISCOVER clinical trial evaluated the effectiveness and safety of Descovy (emtricitabine and tenofovir alafenamide) compared to Truvada (emtricitabine and tenofovir disoproxil fumarate) for HIV prevention. This study was one of the largest PrEP (pre-exposure prophylaxis) trials conducted to date.

• DISCOVER was a randomized, double blind Phase 3 study with 5,335 participants, researchers looked at efficacy of Descovy vs Truvada for HIV prevention (PrEP), and weight change was evaluated as an additional outcome. Participants included HIV-seronegative men (N=5,262) or transgender women (N=73) who have sex with men and are at risk of HIV-1 infection with a median age of 34 years.
• Those taking Descovy for PrEP gained significantly more weight than those in the Truvada group: an average of 1.1 kg (2.4 lbs) with Descovy compared to a mean weight loss of 0.1 kg in those taking Truvada over 48 weeks (p<0.0001).
• People in the Truvada group lost weight in the first 24 weeks of the study (a reported side effect in FDA-approved package labeling) but returned to their baseline (starting) weight by week 48. The authors state that the weight gain seen with Descovy for PrEP is in line with the annual weight gain seen in the general populations of the U.S (0.5 to 1 kg per year) and western Europe.
• By the end of 96 weeks, both groups had increases in weight, with people who took Descovy gaining a median of 1.7 kg (3.7 lbs), and people receiving Truvada gaining a median of 0.5 kg (1.1 lbs).
• In the DISCOVER trial, the low weight loss with Truvada was likely due to the known TDF-associated weight-suppressive effect, with participants returning to their baseline (starting) weight by week 48. The weight gain with Descovy was similar to that seen in the general US population and the iPrEx trial, which suggests a normal trajectory of weight gain over time.

It is important to note that modest weight loss (3% Truvada vs. 2% placebo), which may be reversible, is listed from the iPrEx trial as an adverse event in the FDA-approved Truvada package labeling. Weight change adverse events (increase or decrease) with Descovy are not noted in its official package labeling.

A subsequent retrospective analysis (unpublished, CROI 2025 poster presentation) by Glidden et al, extrapolated data from the DISCOVER PrEP trial and the 2010 iPrEx trials using a linear mixed model and concluded that after 96 weeks there would be no statistically or clinically significant differences in mean weight gain with Descovy compared with placebo (a pill that contains no medicine).

• This study looked at weight gain in two studies (iPrEx and DISCOVER) of people who did not have HIV but who took preventive medication for HIV (PrEP)
• The weight gained by people without HIV who took Descovy compared with people who took placebo was similar. Any difference was too small to be meaningful, suggesting that Descovy is weight neutral and follows trends within the general population.
• Prospective, randomized clinical trials with weight gain as a primary outcome are required to confirm these findings.

Related questions

• Descovy vs Truvada: How do they compare for HIV / PrEP?
• Apretude vs Descovy: How do they compare?
• Who are the actors in the Descovy commercial?

Lipid level changes and metabolic effects with Descovy

Some evidence suggests that tenofovir alafenamide (TAF) use may lead to increases in lipid levels, but how this might affect cardiovascular outcomes, like heart disease, heart attack or stroke, is not fully known.

In an 18-month long cohort trial, lipid levels were assessed among 4,375 adults living with HIV who switched from a tenofovir disoproxil fumarate (TDF)-containing regimen to a TAF regimen. Follow-up continued for 2.5 years. Results showed that those who switched to the tenofovir alafenamide (TAF) regimen led to elevations in mean total cholesterol, high density lipoprotein (LDL) cholesterol and low-density lipoprotein (LDL) cholesterol after 18 months.

A multicenter, prospective cohort, 144 week-long study in 1,446 people living with HIV who switched from TDF to TAF-containing regimens found that individuals who switched to TAF had a significant increase in total cholesterol (+7.9 mg/dL) and triglycerides (+11.2 mg/dL), but no differences in the total cholesterol / high-density lipoprotein (HDL) ratio (an indicator of cardiovascular risk). In addition, no increased incidence of lipid-lowering drug use was observed after the follow-up period.

The product label for Descovy states that in adults living with HIV who had not received ART and were treated with elvitegravir, cobicistat, emtricitabine, and tenofovir alafenamide (brand: Genvoya), mean increases of 30 mg/dL of total cholesterol, 15 mg/dL of LDL-C, 7 mg/dL of HDL-C, and 29 mg/dL of triglycerides occurred after 48 weeks of use. However, it’s important to note that other components found in combination products like Genvoya (for example: elvitegravir) may also cause elevated lipid levels.

Not all studies have shown significant changes in lipids with Descovy. For example, in the DISCOVERY trial, participants in the TAF group showed minimal changes in most blood lipids. Data up to 96-weeks in length showed the following lipid changes when Descovy was compared to Truvada:

• Total cholesterol, HDL and LDL levels (fasted): With Descovy, a -1 to -2 mg/dL reduction in total, HDL and LDL cholesterol vs. a -4 to -13 reduction with Truvada. Decreases from baseline were seen in LDL, HDL, and total cholesterol levels in both arms.
• Triglyceride levels (fasted): With Descovy, a +6 mg/dL increase in triglyceride levels vs. a -7 mg/dL reduction with Truvada. The Descovy arm had increases in triglycerides vs decreases in the FTC/TDF arm; however, both were still within the normal range of values.
• The total-cholesterol-to-HDL ratio, which is an indicator of cardiovascular risk and is more predictive than individual blood lipid levels, was similar for Descovy and Truvada. The increases in lipid levels with Descovy also appear to be reversible. Studies have shown that when people switch back to Truvada from Descovy, their lipid levels usually return to their baseline values.

Your healthcare provider may decide to monitor lipid levels while you are being treated with Descovy. In some cases, you may need to switch to TDF if elevated blood lipids levels occur. Be sure to discuss your health risks, including weight and heart risks, with your doctor before starting treatment.

Why else may I gain weight with ART?

• Positive health outcomes: People treated for HIV may replenish their fat stores and gain weight as their appetite and health improves.
• Changes in metabolism: Antiretroviral therapy (ART) may affect metabolism and lead to weight gain or fat redistribution in the body. Studies have shown that people living with HIV on ART gain weight faster than HIV-negative people of a similar age, regardless of their baseline weight.
• Use with other ART medicines: In some people being treated for HIV, weight gain with Descovy may be more likely if combined with integrase strand transfer inhibitors (InSTI) treatment (for example: bictegravir or elvitegravir), compared to those containing Truvada.
• Individual results: Weight gain may vary among patients. Not all people who use Descovy will gain weight or experience lipid changes. To help control your weight and lipids, follow a healthy diet and exercise plan.

If you have experienced a rapid or unexpected weight change or have concerns about your weight, contact your doctor for further evaluation. Your doctor will monitor you for these changes, and make adjustments in therapy, if needed.

Do not stop your ART or PrEP regimen unless directed by your healthcare provider, as this may increase the risk of drug resistance, which can make your medicines less effective.

Related: Does Biktarvy cause weight gain?

This is not all the information you need to know about Descovy or Truvada for safe and effective use and does not take the place of your healthcare provider's directions. Review the full product information and discuss this information and any questions you have with your doctor or other healthcare provider.

References

• Descovy prescribing information. 4/2024. Foster City, CA. Gilead Sciences, Inc. Accessed May 16, 2025 at https://www.gilead.com/~/media/Files/pdfs/medicines/hiv/truvada/truvada_pi.pdf
• Truvada prescribing information. 4/2024. Foster City, CA. Gilead Sciences, Inc. Accessed May 16, 2025 at https://www.gilead.com/-/media/files/pdfs/medicines/hiv/truvada/truvada_pi.pdf
• Mallon PW, Brunet L, Hsu RK, et al. Weight gain before and after switch from TDF to TAF in a U.S. cohort study. J Int AIDS Soc. 2021 Apr;24(4):e25702. doi: 10.1002/jia2.25702.
• Surial B, Mugglin C, Calmy A, et al. Weight and Metabolic Changes After Switching From Tenofovir Disoproxil Fumarate to Tenofovir Alafenamide in People Living With HIV : A Cohort Study. Annals of Internal Medicine. 2021;174(6):758-767. doi:10.7326/M20-4853.
• Alcron K. Rapid weight gain after switching to TAF, regardless of other HIV drugs taken. NAM AIDSMap. July 4, 2020. Accessed Feb 3, 2025.
• Mayer KH, Molina JM, Thompson MA, et al. Emtricitabine and tenofovir alafenamide vs emtricitabine and tenofovir disoproxil fumarate for HIV pre-exposure prophylaxis (DISCOVER): primary results from a randomised, double-blind, multicentre, active-controlled, phase 3, non-inferiority trial. Lancet. 2020 Jul 25;396(10246):239-254. doi: 10.1016/S0140-6736(20)31065-5
• Martínez-Sanz J, Serrano-Villar S, Muriel A, et al. Metabolic-Related Outcomes After Switching From Tenofovir Disoproxil Fumarate to Tenofovir Alafenamide in Adults With Human Immunodeficiency Virus (HIV): A Multicenter Prospective Cohort Study. Clin Infect Dis. 2023 Feb 8;76(3):e652-e660. doi: 10.1093/cid/ciac621
• Descovy.com. Gilead Sciences, Inc. Accessed Feb. 3, 2025 at https://www.descovyhcp.com/adverse-reactions-and-discontinuations
• Lipid increases after switching from TDF to TAF are reversible when treatment is changed back to TDF. 12/10/2019. AIDSMAP. Accessed Feb. 3, 2025 at https://www.aidsmap.com/news/dec-2019/lipid-increases-after-switching-tdf-taf-are-reversible-when-treatment-changed-back
• Highleyman L. Switching Back to Older Tenofovir Improves Lipid Levels. 9/5/2019. POZ. Accessed Feb. 3, 2025 at https://www.poz.com/article/switching-back-older-tenofovir-improves-lipid-levels
• Alcorn K. People with HIV gain weight faster than HIV-negative people. AIDSMAP. July 4, 2020. Accessed Feb 3, 2025 at https://www.aidsmap.com/news/jul-2020/people-hiv-gain-weight-faster-hiv-negative-people
• Ogbuagu O, Ruane PJ, Podzamczer D, et al. Supplementary appendix Long-term safety and efficacy of emtricitabine and tenofovir alafenamide vs emtricitabine and tenofovir disoproxil fumarate for HIV-1 pre-exposure prophylaxis: week 96 results from a randomised, double-blind, placebo-controlled, phase 3 trial.  Lancet HIV . 2021;8(7):1-21.
• Campbell T, Clarke A, Trottier B, et al. Safety and Efficacy of F/TAF and F/TDF for PrEP in DISCOVER Participants Taking F/TDF for PrEP at Baseline [Poster 995]. Poster presented at: IDWeek 2020; October 21-25, 2020.
• Glidden DV, Mulligan K, McMahan V, et al. Metabolic Effects of Pre-Exposure Prophylaxis with Co-Formulated Tenofovir Disoproxal Fumarate and Emtricitabine.  Clinical Infectious Disease. 2018.
• Glidden D, Whiteman A, Tian Y, et al. Weight Change on F/TAF Versus Placebo: Using Common F/TDF Groups to Bridge Data Across Clinical Trials. [Poster 892]. Poster presented at: CROI 2025; March 9-12, 2025; San Francisco, CA, USA.
• TRUVADA, Gilead Sciences Inc. TRUVADA® (emtricitabine and tenofovir disoproxil fumarate) tablets, for oral use. U.S. Prescribing Information. Foster City, CA. Revised April 2024. 2024.
• Grant RM, Lama JR, Anderson PL, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363(27):2587-2599. doi:10.1056/NEJMoa1011205

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