You have four FDA-approved options. Truvada (or its generic) is a daily pill for anyone at risk through sex or injection drug use. Descovy is a daily pill for sexually active people, but not for those at risk through receptive vaginal sex. Apretude is an injection every two months. Yeztugo (lenacapavir) is an injection twice a year.
The four options, and who each is for
HIV.gov lists all four. Truvada (emtricitabine/tenofovir disoproxil fumarate) is for all people at risk for HIV through sex or injection drug use, and generic versions are available. Descovy (emtricitabine/tenofovir alafenamide) is for sexually active men at risk of getting HIV, and is not for women who are at risk through receptive vaginal sex. Apretude (cabotegravir) is for adults and adolescents at risk through sex who weigh at least 77 pounds, given by injection every other month. Yeztugo (lenacapavir) is for the same weight-eligible group, given by injection twice yearly, with a starter dose of oral pills for the first two days.[1]
CDC's clinical guidance is more specific about the exclusion: emtricitabine with tenofovir alafenamide has not yet been studied for HIV prevention among people assigned female at birth who could get HIV through receptive vaginal sex, so there are two PrEP regimens approved for use by women — daily oral F/TDF and cabotegravir injections every two months.[2]
For adolescents, CDC notes PrEP is recommended for those without HIV weighing at least 77 pounds, and that daily oral F/TDF and F/TAF are FDA-approved options for adolescents.[2]
How well each one works
For oral PrEP, HIV.gov states PrEP reduces the risk of getting HIV from sex by about 99% when taken as prescribed, and by at least 74% among people who inject drugs — with the caveat that PrEP is much less effective when it isn't taken consistently.[1]
For lenacapavir, the trial data are striking. Gilead reports that 99.9% or more of participants who received Yeztugo in the Phase 3 PURPOSE 1 and PURPOSE 2 trials remained HIV negative: zero HIV infections among 2,134 participants in PURPOSE 1 among cisgender women in sub-Saharan Africa, and two infections among 2,179 participants in PURPOSE 2 across a geographically diverse group of cisgender men and gender-diverse people — superior to daily oral Truvada in both trials.[3]
CDC now recommends lenacapavir, administered as subcutaneous injections every six months, as a PrEP option for people weighing at least 35 kilograms — a strong recommendation based on high certainty of evidence.[4]
Timing, dosing, and logistics
Pills take days to reach full protection. CDC states PrEP pills reach maximum protection from HIV at about 7 days of daily use for receptive anal sex, and at about 21 days of daily use for receptive vaginal sex and injection drug use, with no data available for insertive sex.[5]
Apretude is started with two injections a month apart, then continues every two months thereafter.[2]
Lenacapavir has a specific loading sequence: on day 1, 927 mg by subcutaneous injection as two 1.5-mL injections at least 4 inches apart, plus 600 mg orally; on day 2, another 600 mg orally; then 927 mg by injection every six months, plus or minus two weeks. Injection sites include the abdomen and anterior thigh. Limited data suggest protective levels are reached 2 hours after the day-2 dose if both oral loading days are taken — but if both are missed, time to protection is estimated at 21 to 28 days.[4]
One thing all four share: CDC requires an HIV test before starting PrEP and routine follow-up visits while on it.[5]
Choosing between them
If you may be exposed through injection drug use, oral F/TDF is the option with an indication that covers you. CDC also states that people who inject drugs that are not prescribed to them should be offered PrEP.[2]
If daily pills are hard to sustain — travel, privacy, work schedule, pill fatigue — injectables remove the daily decision entirely. Two visits a year for lenacapavir is the least frequent option currently available.
If you have started and stopped PrEP before, or are coming off PEP, that history is relevant. CDC notes PrEP can help protect people who have been prescribed PEP and report continued risk or have used multiple courses of PEP.[5]
There is no wrong answer among the four, and switching is normal. The best regimen is the one you will actually stay on.
Florida angle: where to start the conversation
Florida county health department STD and sexual health clinics provide PrEP services, and the Department of Health maintains a state PrEP and PEP resource page with factsheets and paying-for-PrEP materials.[6] Cost should not narrow your options: federal guidance issued in October 2024 confirmed most employer, Marketplace, and individually purchased plans must cover specified PrEP formulations — including long-acting injectable PrEP — without cost sharing.[7] Florida also publishes its own step-by-step flow sheet for covering PrEP medication costs, including the manufacturer patient assistance route for uninsured patients.[8]
Related questions
Which PrEP option is best for women?
Two regimens are approved for women: daily oral emtricitabine/tenofovir disoproxil fumarate, and cabotegravir injections every two months. Lenacapavir is also recommended by CDC for people weighing at least 35 kilograms and was studied in cisgender women in PURPOSE 1. Descovy has not been studied for people at risk through receptive vaginal sex.
Can I switch between PrEP options?
Yes, and plenty of people do. Switching from pills to an injectable, or between injectables, is a normal clinical decision made with your provider, who will handle the timing so you are not left with a gap in protection. Bring up what is not working — cost, schedule, side effects — rather than stopping on your own.
How soon does PrEP start working?
Oral PrEP reaches maximum protection at about 7 days of daily use for receptive anal sex and about 21 days for receptive vaginal sex or injection drug use. Lenacapavir may reach protective levels within hours of the day-2 oral loading dose, but 21 to 28 days if both oral loading days are missed.
Do I still need condoms on PrEP?
PrEP prevents HIV and nothing else. Gonorrhea, chlamydia, syphilis, and hepatitis all transmit independently, so condoms and regular STI screening remain useful alongside PrEP. Many people on PrEP use condoms situationally rather than always, and doxy-PEP is another tool worth asking about.
Related from RiseUpToHIV
References & Sources
- HIV.gov — Pre-Exposure Prophylaxis (PrEP). Lists Truvada, Descovy, Apretude, and Yeztugo with who each is for, and states PrEP reduces sexual HIV risk by about 99% and injection risk by at least 74%.. ↩ ↩
- CDC HIV Nexus — Clinical Guidance for PrEP. Documents the F/TDF, F/TAF, and cabotegravir regimens, the receptive vaginal sex exclusion for F/TAF, the two regimens approved for women, adolescent options, and cabotegravir dosing intervals.. ↩ ↩ ↩ ↩
- Gilead Sciences — Yeztugo (lenacapavir) FDA approval announcement. Reports PURPOSE 1 zero infections among 2,134 participants, PURPOSE 2 two infections among 2,179, and 99.9% or more of Yeztugo participants remaining HIV negative.. ↩
- CDC MMWR — Clinical Recommendation for the Use of Injectable Lenacapavir as HIV PrEP. Recommends lenacapavir every six months for people weighing at least 35 kg, and gives the day 1 / day 2 loading and maintenance dosing, injection sites, and time to protection.. ↩ ↩
- CDC — Preventing HIV with PrEP. States time to maximum protection for oral PrEP, the required HIV test before starting and routine follow-up, and that PrEP can help people who have used multiple courses of PEP.. ↩ ↩ ↩
- Florida Department of Health — PrEP and PEP. State PrEP and PEP resource page with factsheets and paying-for-PrEP materials.. ↩
- HIV.gov — Updated Coverage Guidance Under the Affordable Care Act for Long-Acting PrEP. Reports the October 2024 requirement that most plans cover specified PrEP formulations, including long-acting injectable PrEP, without cost sharing.. ↩
- Florida Department of Health — How to Cover the Cost of PrEP Medication. Florida's step-by-step PrEP cost pathway including manufacturer patient assistance for uninsured patients.. ↩
Community publications like POZ, Positively Aware, and TheBody inform framing and lived-experience context on RiseUpToHIV. Every clinical, epidemiological, or public-health claim above is anchored to a primary source.