A physician in the rural Southwest called about a 27-year-old HIV-positive man who has been taking emtricitabine/rilpivirine/tenofovir alafenamide for the past two years. He has had no opportunistic infections or other HIV-related complications, but has developed gastroesophageal reflux disease (GERD) and will require medication to treat it- the caller was considering lansoprazole, which is on the patient’s insurance formulary. His CD4 count is 530 cells/µL and viral load is undetectable. The caller asked for guidance on medication interactions between the patient’s ARVs and lansoprazole.
The HIV Warmline physician and clinical pharmacist cautioned that rilpivirine and lansoprazole cannot be taken together, since co-administration would decrease rilpivirine levels and possibly lead to HIV treatment failure. They helped the caller identify other therapeutic options for treating the patient’s GERD and also reviewed the latest HIV laboratory (CD4 and viral load) monitoring recommendations. Other health measures were discussed, including STI prevention and screening. Because many rural pharmacies do not have expansive in-store ARV stocks, the Warmline team also recommended that the caller reach out early to the patient’s insurance carrier and pharmacy to ensure medication availability when the patient’s current supply is exhausted, as treatment interruption can lead to drug resistance and treatment failure.