Compare PrEP Medications: Truvada vs Descovy vs Apretude vs Lenacapavir

⚡ Key takeaways

There's no single “best” PrEP — it depends on exposure, kidneys/bones, pill vs injection, cost and pregnancy plans.
Truvada suits almost everyone and is cheapest; Descovy is gentler on kidneys/bones but not for vaginal sex.
Apretude & lenacapavir remove the daily pill; 2-1-1 suits infrequent, plannable anal sex.
PrEP is HIV-only — pair it with testing, condoms and, where useful, Doxy-PEP.

01Full comparison table

Every option across the factors that actually decide the choice. Scroll sideways on mobile.

	TruvadaTDF	DescovyTAF	ApretudeCAB	LenacapavirYeztugo	2-1-1on-demand
Form	Daily pill	Daily pill	Injection / 2 mo	Injection / 6 mo	Pills around sex
Approved for	All exposures	Anal only	All exposures	All exposures	Anal, MSM
Time to protect (anal)	~7 days	~7 days	On schedule	After initiation	Pre-dose 2–24 h
Time to protect (vaginal)	~20 days	Not approved	On schedule	After initiation	Not for vaginal
Kidney	Monitor	Minimal	None	None	Monitor
Bone	~2–4% yr1	Negligible	None	None	Low
Weight / lipids	Neutral	+1–3 kg	Minimal	Minimal	Neutral
Signature effect	Early nausea	Weight / lipids	Injection-site	Injection-site	Fewer pills
Pregnancy	Recommended	Limited data	Can use	Emerging data	No
Cost	Cheapest	Brand	High	High	Low (generic)

“On schedule” = protective once the injection series is given at the recommended times. Read each medicine's full guide below.

02Which PrEP is right for you?

A quick way to narrow it down — tap any card for the full guide.

Choose Truvada if…you want the cheapest option, have vaginal exposure, or want on-demand dosing. Choose Descovy if…you have kidney/bone concerns or are over 50 — and your exposure is anal. Choose Apretude if…you'd rather not take a daily pill and can attend a clinic every 2 months. Consider Lenacapavir if…you want the fewest doses — just two injections a year. See it vs Apretude.

03On-demand “2-1-1” dosing — read this first

For anal sex, Truvada can be taken around sex rather than daily: 2 pills 2–24 h before, then 1 pill at 24 h and 1 pill at 48 h. It's convenient for infrequent, plannable sex — but it comes with firm limits.

Important safety & legal note. On-demand 2-1-1 dosing is WHO-recommended for MSM in Europe, Canada and Australia, but it is NOT FDA-approved in the US and has not been studied for vaginal exposure. It must not be used for vaginal sex or with Descovy/injectables. Consult your provider before using this regimen.

04Lenacapavir (Yeztugo) — the twice-a-year option

Approved by the FDA in 2025, lenacapavir is a long-acting capsid inhibitor given as a subcutaneous injection just twice a year. In the PURPOSE trials it showed near-complete protection, including in cisgender women. It's the newest and least-frequent option — availability and cost are still settling.

See lenacapavir in context with every regimen on the PrEP options & dosing page →

💡Still comparing?

Read a full side-effect deep-dive for any medicine, or check whether your other medications interact with PrEP.

PrEP options & dosing → Drug interaction checker

05PrEP alternatives: other ways to prevent HIV

PrEP is highly effective, but it's part of a bigger toolkit. Depending on your situation, alternatives or add-ons include:

Condoms — also protect against other STIs (PrEP doesn't).
PEP — emergency medicine within 72 hours after a possible exposure (not a substitute for ongoing PrEP).
U=U (treatment as prevention) — a partner with HIV who is on treatment and undetectable cannot pass on HIV sexually. See serodifferent couples.
Regular testing & Doxy-PEP — to find and cut bacterial STIs alongside HIV prevention.
A different PrEP regimen — if a daily pill doesn't suit you, on-demand 2-1-1 or a long-acting injection may.

06Frequently asked questions

QWhat is the best PrEP medication?

There is no single best PrEP — the right choice depends on your exposure type, kidney and bone health, whether you want a pill or an injection, cost, and pregnancy plans. Truvada suits almost everyone and is cheapest; Descovy is gentler on kidneys/bones but not for vaginal sex; Apretude and lenacapavir remove the daily pill; 2-1-1 suits infrequent, plannable anal sex.

QIs Truvada or Descovy better?

Descovy is gentler on the kidneys and bones and causes less early nausea, so it suits people with kidney concerns, low bone density or who are over 50. Truvada is cheaper (generic), approved for all exposures including vaginal sex, and can be used on-demand. Descovy is not approved for vaginal sex and is linked to modest weight/lipid gain.

QWhat is 2-1-1 on-demand PrEP and who can use it?

2-1-1 is event-driven Truvada dosing for anal sex: 2 pills 2–24 hours before sex, then 1 pill at 24 hours and 1 pill at 48 hours. It is WHO-recommended for men and trans women who have sex with men and is standard in Europe, Canada and Australia. It is NOT FDA-approved in the US and has not been studied for vaginal sex.

Full side-effect guides

Truvada side effectsTDF/FTC · daily generic pill Descovy side effectsTAF/FTC · gentler daily pill Apretude side effectsCAB · 2-monthly injection Options & dosing+ Lenacapavir & 2-1-1 Symptom body-mapCheck any symptom by area PEP (72-hour)Emergency prevention

🔬 Sources & review

U.S. FDA — Prescribing Information for Truvada, Descovy, Apretude and Yeztugo (lenacapavir).
U.S. CDC — PrEP Clinical Practice Guideline (2021); WHO Consolidated HIV Prevention Guidelines (2021, 2022–2024 updates).
USPSTF PrEP Recommendation (2023); IPERGAY, DISCOVER, HPTN 083/084 and PURPOSE-1/2 trials.

✔ Last medically reviewed: 3 July 2026 · Prepmedication.com Medical Review Team · Next review due: January 2027 · How we review →

Medical disclaimer. This comparison is general information, not a diagnosis or prescription. Approvals and dosing vary by country and change over time; always confirm your plan with a qualified clinician. If you may have been exposed to HIV in the last 72 hours, see PEP now.