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The United States has four approved PrEP medication options for eligible adults and adolescents weighing at least 35 kg (77 lb): daily Truvada or generic F/TDF, daily Descovy, Apretude injections every two months after initiation, and Yeztugo injections every six months after initiation. Descovy is not approved for receptive vaginal exposure. A clinician helps match the regimen to your exposure route, health and follow-up needs.[1][9][10]
The four options, and who each is for
The options are daily F/TDF (Truvada or generic), daily F/TAF (Descovy), injectable cabotegravir (Apretude) and injectable lenacapavir (Yeztugo). F/TDF is recommended for prevention through sex or injection drug use. Descovy’s PrEP indication covers eligible people at risk through sex except receptive vaginal sex; the restriction concerns exposure route, not simply gender. Apretude and Yeztugo are approved for prevention of sexually acquired HIV, with initiation schedules before their maintenance injections.[9][10][1]
For receptive vaginal exposure, there are now three approved options: F/TDF, cabotegravir and lenacapavir. NIH’s March 2026 perinatal guideline recommends TDF/FTC and lenacapavir during pregnancy and breastfeeding and says cabotegravir can be considered through shared decision-making. Descovy remains excluded for this exposure route.[11][2]
All four options have a PrEP indication for eligible adolescents weighing at least 35 kg (77 lb), with the same product-specific exposure restrictions. HIV must be excluded before PrEP is started.[10][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]
In the primary efficacy analyses of PURPOSE 1 and PURPOSE 2, there were zero HIV infections among 2,134 participants receiving lenacapavir and two among 2,179, respectively. Both trials found lower HIV incidence with lenacapavir than with daily oral F/TDF in the study populations. These are trial outcomes over follow-up, not a guarantee of protection for every individual.[4][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
CDC estimates that daily oral F/TDF reaches maximum drug levels associated with protection after about seven days for receptive anal sex and up to about 21 days for receptive vaginal sex and injection drug use. Data do not establish the corresponding timing for insertive sex. Do not apply these oral-PrEP timing estimates to every injectable product.[5]
Apretude is started with two injections a month apart, then continues every two months thereafter.[2]
Yeztugo starts with two subcutaneous injections totaling 927 mg plus 600 mg orally on day 1, followed by 600 mg orally on day 2. Continuation injections are every 26 weeks, with a two-week window. CDC estimates protective levels within two hours after the day-2 tablets when both oral loading days are taken; the FDA label requires the complete initiation schedule. If a loading dose is missed, contact the prescriber rather than assuming the injection alone provides immediate protection.[10][4]
All PrEP options require HIV testing before starting and regular follow-up. Injectable products require product-specific testing around injections, and symptoms of possible acute HIV need prompt assessment. Kidney function, hepatitis B, medication interactions and pregnancy plans can also affect which option fits.[2][10][5]
Choosing between them
For HIV exposure through injection drug use, daily oral F/TDF is the PrEP option CDC recommends; the injectable products’ approved indications concern sexual acquisition. Sterile injection equipment and substance-use services remain part of prevention.[2]
Injectable PrEP may help when daily pills are difficult. Lenacapavir has the least frequent maintenance injections, every six months, but starting doses, HIV testing, STI care or other follow-up can require additional visits.[4]
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]
The best fit is a regimen that is appropriate for your exposure route and health and that you can keep using with the required follow-up. Side effects, kidney function, hepatitis B, interactions, cost and personal preference all matter. Plan switches with your provider so protection continues.[2][4]
Florida angle: where to start the conversation
Florida DOH provides PrEP and PEP service information and medication-assistance resources; clinic offerings vary. October 2024 federal guidance addressed coverage of the specified oral regimens and cabotegravir without cost sharing in most non-grandfathered health plans. That guidance predates lenacapavir approval, so confirm coverage for the chosen product and associated visits. Medicare Part B now covers FDA-approved PrEP, including lenacapavir, and related covered services without cost sharing. Ask about assistance if you are uninsured or encounter a coverage barrier.[12][6][7][8]
Related questions
Which PrEP option is best for women?
For receptive vaginal exposure, approved options include daily F/TDF, injectable cabotegravir and injectable lenacapavir. Descovy is not approved for this route. If you are pregnant or breastfeeding, NIH recommends TDF/FTC or lenacapavir and says cabotegravir can be considered after discussing the benefits and uncertainties with your clinician.[9][11]
Can I switch between PrEP options?
Yes, when clinically appropriate. Work with your provider to plan timing, HIV testing and any needed bridging so you do not have an unintended gap. People taking tenofovir-based PrEP also need hepatitis B considered before stopping or switching, because stopping an active hepatitis B medicine can cause a flare.[2][4]
How soon does PrEP start working?
The estimate depends on the product and exposure route. For daily F/TDF, CDC gives about seven days for receptive anal sex and up to 21 days for receptive vaginal sex or injection drug use. Yeztugo has a required two-day oral loading schedule alongside the initial injections; ask the prescriber about protection and missed doses rather than substituting an oral-PrEP estimate.[2][4][10]
Do I still need condoms on PrEP?
PrEP is prescribed to prevent HIV; it should not be relied on to prevent other sexually transmitted infections or pregnancy. Condoms, relevant vaccines and regular STI screening remain useful. A clinician can discuss other prevention measures for your circumstances.[2]
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. Oral and cabotegravir dosing, monitoring and eligibility. Read alongside the separate lenacapavir recommendation and current NIH perinatal guidance. Source. ↩↩↩↩ ↩ ↩ ↩ ↩ ↩
- 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 Can I Pay for PrEP?. Florida's fact sheet links insurance and medication-assistance routes for paying for PrEP. ↩
- FDA — Descovy prescribing information, June 2025; PrEP eligibility and exclusion for receptive vaginal exposure. Source. Checked September 21, 2026. ↩ ↩ ↩
- FDA — Yeztugo prescribing information; complete initiation schedule, 26-week continuation, HIV testing and missed doses. Source. Checked September 21, 2026. ↩ ↩ ↩ ↩ ↩ ↩
- NIH Perinatal Guidelines — PrEP during conception, pregnancy and breastfeeding, March 2026; TDF/FTC, lenacapavir and cabotegravir. Source. Checked September 21, 2026. ↩ ↩
- CMS — Medicare coverage of PrEP, including lenacapavir and related services without Part B cost sharing. Source. Checked September 21, 2026. ↩
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.