Managing Heartburn in HIV Patients on Emtricitabine/Rilpivirine/Tenofovir Alafenamide

Critical Drug-Drug Interactions

• The International Antiviral Society-USA guidelines recommend considering drug-drug interactions as a valid reason to switch antiretroviral regimens in virologically suppressed patients, such as switching from a rilpivirine-containing regimen to an alternative like bictegravir/emtricitabine/tenofovir alafenamide or dolutegravir-based regimens, which would allow the use of proton pump inhibitors (PPIs) for heartburn management 1, 2
• Bictegravir/emtricitabine/tenofovir alafenamide is an alternative ART regimen that does not contain rilpivirine and allows for PPI use, as it is an integrase inhibitor-based regimen with no acid-dependent absorption 1
• Dolutegravir-based regimens are another alternative, being integrase inhibitors with minimal drug interactions, and can be used with PPIs for heartburn management 1, 2