was considered minimal and did not lead to osteoporosis. When comparing bone fractures between active participants and control there was no major difference in bone fractures. Fat redistribution and accumulation was more commonly seen in individuals receiving antiretroviral therapy, particularly older antiretrovirals, for the treatment of HIV. No significant changes in fat redistribution or change in fat had been noted when used as a pre-exposure prophylaxis. Research and study outcome analysis suggests that emtricitabine/tenofovir does not have a significant effect on fat redistribution or accumulation when used as pre-exposure prophylaxis in HIV negative individuals. As of early 2018 these studies have not assessed in detail subtle changes in fat distribution that may be possible with the drug when used as PrEP, and statistically significant – though transient – weight changes have been attributed to detectable drug concentrations in the body. Other potential serious side effects of Truvada include acute exacerbations of hepatitis B in individuals with HBV infection, lactic acidosis, and severe hepatomegaly with steatosis. Descovy research and data from public use has shown similar "start-up" effects; however, some data indicates that Descovy is better for one's kidneys and for those with a diagnosis of osteoporosis. The DISCOVER trial that compared descovy versus truvada for PrEP showed that descovy produced safer kidney and bone outcomes. Boxed warnings Both Truvada and Descovy carry a black box warning for the combination of emtricitabine/tenofovir, as this combination of drugs can result in the acute worsening of hepatitis B infection when discontinued. This combination of drugs is also known to increase HIV resistance to these medications when used as pre-exposure prophylaxis (PrEP) in individuals who have already (recently) been infected with HIV. It is recommended that individuals continue to periodically get tested to determine their HIV status to ensure proper continuing use of these medications for PrEP. Society and culture Access and adoption Approval for use Truvada was previously only approved by the U.S. Food and Drug Administration (FDA) to treat HIV in those already infected. In 2012, the FDA approved the drug for use as pre-exposure prophylaxis (PrEP), based on growing evidence that the drug was safe and effective at preventing HIV in populations at increased risk of infection. The FDA has approved two additional medications for PrEP since then, approving Descovy in 2019 and cabotegravir (Apretude) in 2021. In 2012, the World Health Organization (WHO) issued guidelines for PrEP and made similar