From the Guidelines
When treating H. pylori infection in patients on dolutegravir-rilpivirine, it is crucial to manage significant drug interactions by temporarily switching the patient to an alternative antiretroviral regimen during H. pylori treatment, as recommended by recent guidelines 1. To minimize potential interactions, the following key points should be considered:
- Dolutegravir and rilpivirine are both part of the antiretroviral regimen Juluca, and their absorption and metabolism can be affected by drugs used to treat H. pylori.
- Proton pump inhibitors (PPIs) like omeprazole, commonly used in H. pylori treatment, can significantly reduce rilpivirine absorption, potentially leading to HIV treatment failure 1.
- If a regimen switch is not possible, medications should be separated by at least 12 hours, and H2-blockers like famotidine can be used instead of PPIs, although this may be less effective for H. pylori eradication.
- Clarithromycin, a common component of H. pylori treatment regimens, can increase rilpivirine levels, potentially causing side effects, due to its effect on the CYP3A4 enzyme pathway 1.
- Metronidazole, another drug used for H. pylori, has no significant interaction with dolutegravir or rilpivirine. Given the complexity of these interactions, consultation with both infectious disease and gastroenterology specialists is essential before initiating H. pylori treatment in patients on dolutegravir-rilpivirine to ensure that HIV suppression is maintained and H. pylori is effectively eradicated.
From the Research
Interactions between Dolutegravir-Rilpivirine and H. pylori Treatment
There is no direct evidence in the provided studies regarding the interactions between dolutegravir-rilpivirine and H. pylori treatment.
H. pylori Treatment Options
- The treatment of H. pylori infection often involves a combination of antibiotics and a proton pump inhibitor (PPI) 2, 3.
- Bismuth quadruple therapy is recommended as the best initial empiric treatment due to the declining efficacy of legacy triple therapies 2.
- Concomitant, sequential, and hybrid therapies are also effective bismuth-free quadruple options, especially when dual clarithromycin-metronidazole resistance is low 2, 4.
- Levofloxacin-, rifabutin-, furazolidone-, and sitafloxacin-containing regimens can be used as salvage options or in areas with high resistance rates 2, 3, 5.
Efficacy of Different Treatment Regimens
- A study found that a 14-day hybrid sequential-concomitant therapy achieved a high eradication rate of 99.1% 4.
- Another study showed that bismuth quadruple therapy with amoxicillin, metronidazole, and clarithromycin achieved high cure rates of 96.9% and 94.9% 5.
- A comprehensive study in Bahrain found comparable cure rates for H. pylori regardless of the antimicrobial regimens used 6.