Drugs suspected to be involved in the DDI-summary
Complete list of drugs taken by the patient
Clinical case description
43 year-old patient with HIV/HCV infection. In February 2020 HIV infection is well controlled (pVL<20 copies/mL) on cART with dolutegravir plus rilpivirine/FTC/TAF (RAMs in complied genotypes RT: 41L, 67N, 70R, 103R, 184V, 188L, 210W, 215Y; PRO: 10I, 46I, 54L, 63P, 71V, 84V, 90M; IN: wild-type). HCV coinfection (SVR since 2015) with liver cirrhosis (Child-Pugh A) and oesophageal varices. Concomitant treatment with famotidine and propranolol. Upper gastrointestinal bleeding in February 2020. Gastroenterologists wanted to prescribe high doses of omeprazol instead of famotidine. Etravirine and dolutegravir co-administration is not recommended without a protease inhibitor, and the patient had prior history of allergic vasculitis while on protease inhibitors. In this context, rilpivirine was changed to doravirine (early access program), maintaining dolutegravir and FTC/TAF. By June 2020 the patient is tolerating well the new treatment, pVL remains undetectable, and no new bleeding episode has occurred.
The case is really interesting and challenging in terms of ARV management, due to the limited options available for this patient. Although the probability of a significant DDI between omeprazol and doravirine is very low, this co-administration has not been studied. Given the limited available data with this co-administration, the case can be useful for clinicians. It illustrates that doravirine can be an alternative to rilpivirine when omeprazole (or other PPI) is required. Given the high genetic barrier of doravirine, this change is also safe in terms of virological suppression.