Date of report 28 Jan 2025

Reported case interaction between
Rilpivirine and Dulaglutide

A 45-year-old male, diagnosed with HIV eight years ago, has been on antiretroviral therapy (ART) with dolutegravir/rilpivirine for the past two years. He is adherent to his HIV treatment and maintains good immunological status, with a viral load consistently below 30 copies/mL over the last seven years.

The patient has a medical history of hypertension, type 2 diabetes mellitus (diagnosed five years ago), obesity (BMI: 33 kg/m²), and non-alcoholic fatty liver disease (NAFLD). The NAFLD diagnosis was confirmed by liver elastography, which demonstrated grade 2 fibrosis, and abdominal ultrasound findings.

Over the past year, the patient presented with persistent poor glycemic control despite treatment with metformin 850 mg twice daily and sitagliptin 100 mg daily. He also reported difficulty losing weight. During an evaluation by the endocrinology department, dulaglutide (a GLP-1 receptor agonist) was introduced at a dose of 1.5 mg weekly as an adjunct to metformin to improve glycemic control and support weight loss. After six months, his dose of dulaglutide was increased to 3 mg weekly. However, the patient did not inform his HIV care team about the initiation of this therapy.

At a six-month follow-up, after initiating dulaglutide, his viral load remained undetectable. However, his attending physician decided to switch his ART regimen to long-acting intramuscular cabotegravir and rilpivirine injections. This decision was made to mitigate potential concerns regarding the absorption and efficacy of oral rilpivirine. Dulaglutide, known to delay gastric emptying and inhibit gastric secretion, could theoretically interfere with rilpivirine absorption, although this coadministration has not been specifically studied.