Emtricitabine with rilpivirine and tenofovir disoproxil

How it works

Rilpivirine inhibits reverse transcriptase at a non-catalytic site, while emtricitabine and tenofovir disoproxil are incorporated into viral DNA by reverse transcriptase to terminate chain elongation.

Prescribing in practice

• Rilpivirine absorption is acid-dependent, so proton pump inhibitors are contraindicated and antacids or H2 antagonists must be time-separated, with the dose taken with food.
• The tenofovir disoproxil component carries a risk of renal tubular injury and reduced bone mineral density, so avoid in significant renal impairment and with other nephrotoxic drugs.
• It is generally reserved for patients with a lower baseline viral load owing to reduced efficacy at high viraemia.

Monitoring

Monitor HIV viral load and CD4 count alongside renal function and liver function during treatment.

Counselling the patient

• Take once daily with food for proper absorption.
• Avoid acid-suppressing heartburn remedies unless advised how to space them.
• Take it every day to maintain control of the virus.

Evidence & guidelines

Rilpivirine-containing fixed-dose therapy is an established option reflected in BHIVA guidance for appropriate patients.