Emtricitabine 200mg / Tenofovir disoproxil 245mg tablets

BackgroundPharmacological treatments for COVID-19 remain limited, particularly for severe outcomes. Tenofovir, an inhibitor of the SARS-CoV-2 RNA-dependent RNA polymerase (RdRp), has been proposed as a therapeutic agent to reduce hospitalization, intensive care unit (ICU) admissions, and mortality.ObjectiveTo assess the efficacy of tenofovir in COVID-19 patients based on randomized controlled trials (RCTs).MethodsA systematic review of RCTs assessing tenofovir in COVID-19 was conducted. Searches in PubMed/MEDLINE, Scopus, Cochrane Library, LILACS, SciELO, and COVID-19 LOVE databases were last updated on April 16, 2025. Risk of bias was evaluated using the Cochrane Risk of Bias 2.0 tool. As a meta-analysis was not feasible, a qualitative analysis was performed. The review protocol was registered in PROSPERO (CRD42023465336).ResultsAmong 1241 retrieved trials, three met the inclusion criteria. These trials, conducted in 32 hospitals across Colombia, Spain and Iran included 1048 patients. In the Colombian study, the combination of tenofovir disoproxil/emtricitabine with colchicine and rosuvastatin was associated with reduced 28-day mortality (risk difference [RD] = -0.05; 95% CI: -0.07 to -0.04) and lower need for invasive mechanical ventilation (RD = -0.08; 95% CI: -0.11 to -0.04). However, randomization bias and small sample size limit the interpretation of these results. Conversely, the Spanish study was classified as having a low risk of bias, but found no significant benefit of tenofovir disoproxil/emtricitabine in reducing 28-day mortality (risk ratio [RR] = 1.76; 95% CI: 0.52 to 5.91) or for the composite outcome of ICU admission, disease progression, and mortality (RR = 0.95; 95% CI: 0.66 to 1.40). The Iranian study, in turn, demonstrated that tenofovir alafenamide, when combined with standard treatment, significantly reduced the need for mechanical ventilation (0.0% vs. 13.3%, p = 0.038) and ICU length of stay (3.3 days vs. 14.5 days; p = 0.04). However, the presence of a high risk of bias, with major concerns regarding co-interventions and statistical analyses, precludes a definitive conclusion regarding these results.ConclusionsThis review identified three clinical trials evaluating the efficacy of tenofovir in COVID-19, with conflicting results. One study suggested a potential benefit in reducing mortality and the need for invasive mechanical ventilation in mild to moderate cases but methodological limitations, including risk of bias and small sample size, weaken its conclusions. The second study found no significant impact on mortality or disease progression. In the third study, no deaths were reported, but he significant reduction in the need for mechanical ventilation and ICU length of stay is extremely limited due to the high risk of bias. Given these inconsistencies and the limitations of available evidence, tenofovir cannot be recommended for COVID-19 treatment.

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Human immunodeficiency virus (HIV) prevention has advanced substantially, yet ending new transmissions by 2030 remains uncertain. Pre-exposure prophylaxis (PrEP) has high biological efficacy, but real-world effectiveness varies due to adherence, access, and delivery barriers. This review aims to synthesize evidence on the efficacy of PrEP in reducing HIV incidence and to discuss its implications for achieving the Joint United Nations Programme on HIV/AIDS (UNAIDS) 2030 targets. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidance, MEDLINE, Embase, Scopus, and Cochrane Library were searched for English-language studies published between January 2010 and January 2025 assessing PrEP efficacy in high-risk populations. Nine randomized controlled trials (RCTs) comprising more than 20,000 participants across multiple continents were included. Across oral tenofovir-based PrEP trials, risk reduction ranged from 49% to 86% in intention-to-treat (ITT) analyses, with markedly higher efficacy in adherence-defined subgroups (e.g., up to 92-99% in trials with pharmacokinetic confirmation). Long-acting injectable cabotegravir (CAB-LA) was superior to daily oral tenofovir disoproxil fumarate-emtricitabine (TDF-FTC) in two large RCTs, with relative risk reduction up to 89% and high observed adherence consistent with clinic-based dosing. Adverse events were generally mild to moderate (gastrointestinal symptoms, headache), with expected renal marker changes in some oral PrEP trials and injection-site reactions for CAB-LA; no consistent evidence of risk compensation was observed. PrEP is highly effective when taken as prescribed, but achieving population-level impact aligned with UNAIDS targets requires scale-up, improved access, and interventions that support persistence and adherence, including expanded delivery models and longer-acting options.

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