Page 66 - SAHCS HIVMed Journal Vol 20 No 1 2019

Southern African Journal of HIV Medicine
ISSN: (Online) 2078-6751, (Print) 1608-9693
Page 1 of 7 Opinion Paper

The role of rilpivirine in Southern Africa

Authors: Rilpivirine, a second-generation non-nucleoside reverse transcriptase inhibitor (NNRTI), is
Michelle A. Moorhouse included as an option in first-line antiretroviral therapy (ART) for antiretroviral-naïve
1
Karen Cohen
2
individuals in treatment guidelines in high-income countries, including the United States and
Affiliations: many European countries. Rilpivirine is available in a single-tablet fixed-dose combination,
1 Wits Reproductive Health has a favourable tolerability profile and is of relatively low cost. However, rilpivirine has
and HIV Institute, University reduced efficacy in patients commencing ART at high viral loads. Therefore, baseline viral load
of the Witwatersrand,
Johannesburg, South Africa testing is required before commencing rilpivirine, and it is not recommended for patients
commencing therapy with a viral load greater than 100 000 copies/mL. Rilpivirine is not
2 Division of Clinical included in the treatment regimens recommended by the World Health Organization (WHO),
Pharmacology, Department which form the basis of treatment guidelines in many lower- and middle-income countries.
of Medicine, University of
Cape Town, Cape Town, Some patients commencing standard first-line regimens experience treatment-limiting toxicity.
South Africa A low-cost rilpivirine-containing fixed-dose combination would potentially be a useful
addition to treatment options available in South Africa and other countries in the region, for
Corresponding author: patients who do not tolerate standard first-line ART. In this article, we explore the utility
Michelle Moorhouse,
[email protected] of rilpivirine as an option in ART in South Africa and the region in the context of current
public-sector regimens. We consider what role rilpivirine might play if first-line therapy moves
Dates: to a dolutegravir-based regimen, as has already happened in some lower- and middle-income
Received: 22 Dec. 2017 countries, including Botswana, Kenya and Brazil. Finally, we describe emerging evidence for
Accepted: 03 Apr. 2019
Published: 29 May 2019 rilpivirine in the prevention of HIV transmission.

How to cite this article: Keywords: HIV; Rilpivirine; Antiretrovirals; Non-nucleoside reverse transcriptase inhibitor;
Moorhouse MA, Cohen K. Southern Africa.
The role of rilpivirine in
Southern Africa. S Afr J HIV
Med. 2019;20(1), a825. Introduction
https://doi.org/10.4102/
sajhivmed.v20i1.825 Rilpivirine, a second-generation non-nucleoside reverse transcriptase inhibitor (NNRTI), is
currently approved for the treatment of HIV-1 infection in more than 80 countries around the
Copyright:
© 2019. The Authors. world. It is included as an option in first-line antiretroviral therapy (ART) for antiretroviral-naïve
Licensee: AOSIS. This work individuals in treatment guidelines in high-income countries, including the United States and
is licensed under the many European countries. Rilpivirine is available in a single-tablet fixed-dose combination, has
1,2
Creative Commons 3
Attribution License. a favourable tolerability profile and is relatively low cost. Because of reduced efficacy in patients
commencing ART at high viral loads, baseline viral load testing is required before commencing
rilpivirine, and it is not recommended for patients commencing therapy with a viral load greater
than 100 000 copies/mL. Rilpivirine has not been included in the treatment regimens recommended
by the World Health Organization (WHO), which form the basis of treatment guidelines in many
lower- and middle-income countries. South Africa has the largest antiretroviral programme in the
world, and purchases antiretrovirals in quantities similar to both the President’s Emergency
Program for AIDS Relief (PEPFAR) and the Global Fund. A low-cost, well-tolerated, single-tablet
regimen would potentially be a useful addition to treatment options available in South Africa and
other countries in the region.

The suitability of any antiretroviral agent for use within large-scale treatment programmes is
determined by a number of factors. These include efficacy; tolerability profile, preferably with no
need for laboratory monitoring for safety issues; interactions with commonly prescribed drugs,
especially those used to treat coinfections such as tuberculosis and hepatitis viruses; convenience
and availability of fixed-dose combinations; availability of paediatric formulations; safety in
pregnancy; and affordability.

Read online: In this article, we explore the utility of rilpivirine as an option in ART in South Africa and the
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smart phone or play if first-line therapy moves to a dolutegravir-based regimen, as has already happened in some
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emerging evidence for rilpivirine in the prevention of HIV transmission.
http://www.sajhivmed.org.za 59 Open Access