Extended-Release HIV Therapies

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The HCPLive Peer Exchange “Optimizing Outcomes in HIV Treatment” features insight and opinion on the latest developments in HIV research, diagnosis, and management from leading physician specialists.

This Peer Exchange is moderated by Paul Doghramji, MD, who is a family physician at Collegeville Family Practice in Collegeville, PA, and Medical Director of health services at Ursinus College, also in Collegeville, PA.

The panelists are:

• Alfred A. DeLuca, MD, Infectious Disease Specialist at CentraState Healthcare System in Manalapan, NJ
• Ian Frank, MD, Director of Anti-Retroviral Clinical Research and Director of Clinical Core at Penn Center for AIDS Research, and Professor of Medicine at the Hospital of the University of Pennsylvania in Philadelphia, PA
• Paul Sax, MD, Associate Professor of Medicine at Harvard Medical School and Clinical Director of the Division of Infectious Diseases and the HIV Program at Brigham and Women's Hospital, in Boston, MA

In this Peer Exchange segment, the panelists discuss the two extended-release HIV treatments, nevirapine and rilpivirine, and how they fit into clinical practice.

There are now extended-release formulations of the non-nucleoside reverse transcriptase inhibitors nevirapine and rilpivirine. The existence of these formulations is important because less frequent dosing can aid in adherence, says Frank. Nevirapine, however, is not used frequently; it is not a preferred agent in treatment guidelines, there are issues with CD4 count—driven administration and because of hypersensitivity reactions, and it is contraindicated in patients who are also taking proton pump inhibitors. In DeLuca’s opinion, “most of the time, there’s no reason to use it,” because of all of these reasons, and also because there is a generic version available that is significantly less expensive. The exception would be, says DeLuca, continuing to treat a patient with nevirapine who has been using it and has been stable with it for years.

On the other hand, rilpivirine is a very small single pill, says Sax, which is good for patients who can’t take larger pills. It can be combined with other drugs, he says, but its caveats are that you have to take it with food and it is contraindicated in patients who are on proton pump inhibitors.

“Nevirapine,” says DeLuca, “has fallen off my radar altogether. On the other hand, rilpivirine has risen on the radar in terms of its inclusion” in the HIV treatment armamentarium.