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International Association of Providers of AIDS Care
Revised December 11, 2017

Fact Sheet 477

Juluca (dolutegravir + rilpivirine)


WHAT IS JULUCA?
WHO SHOULD TAKE IT?
WHAT ABOUT DRUG RESISTANCE?
HOW IS IT TAKEN?
WHAT ARE THE SIDE EFFECTS?
HOW DOES IT REACT WITH OTHER DRUGS?
THE BOTTOM LINE


WHAT IS JULUCA?
Juluca is a combination pill that contains two HIV medications: dolutegravir (Tivicay; see Fact Sheet 467) and rilpivirine (Edurant; see Fact Sheet 435). Juluca is the first complete two-drug HIV regimen. Juluca is manufactured by ViiV Healthcare and Janssen Pharmaceuticals.

Dolutegravir is an integrase inhibitor (or INSTI). Rilpivirine is a non-nucleoside reverse transcriptase inhibitor (a “non-nuke” or NNRTI). These drugs stop HIV from multiplying by preventing the virus’ integrase and reverse transcriptase enzymes, respectively, from working. These enzymes change HIV’s genetic material (RNA) into DNA and incorporate the viral genes into the human chromosome. These processes are shown on Fact Sheet 106, steps 4 and 5. The drugs in Juluca block these processes.

 


 WHO SHOULD TAKE IT?

Juluca was approved in 2017 as a complete maintenance antiretroviral regimen for people who are currently on stable treatment with suppressed virus for at least 6 months and do not have a history of treatment failure or viral drug resistance.

While antiretroviral therapy (ART) is recommended for all people living with HIV, no matter what your symptoms or CD4 count (see Fact Sheet 124), you and your health care provider should consider your CD4 cell count, your viral load (see Fact Sheet 125), any symptoms you are having, and your attitude about taking HIV medications. Fact Sheet 404 has more information about guidelines for the use of antiretroviral drugs (ARVs).

If you take Juluca, you can reduce your viral load to extremely low levels, and increase your CD4 cell counts. This should mean staying healthier longer.

 


 WHAT ABOUT DRUG RESISTANCE?

Many new copies of HIV are mutations. They are slightly different from the original virus. Some mutations can keep multiplying even when you are taking an ARV. When this happens, the drug will stop working. This is called “developing resistance” to the drug. See Fact Sheet 126 for more information on resistance.

Sometimes, if your virus develops resistance to one drug, it will also have resistance to other ARVs. This is called “cross-resistance.” Cross-resistance between efavirenz, delavirdine, nevirapine, etravirine and rilpivirine (all NNRTIs) develops very easily. If you develop resistance to one of these NNRTIs, you probably won’t be able to use any of them in your ART.

Resistance can develop quickly. It is very important to take ARVs according to instructions, on schedule, and not to skip or reduce doses.

 


HOW IS IT TAKEN?
Juluca is taken by mouth as a tablet. The normal adult dose is one tablet, once a day with a meal. Each tablet includes 50 milligrams (mg) dolutegravir and 25 mg rilpivirine.

Dolutegravir and rilpivirine are generally safe for patients with mild or moderate kidney or liver problems.

 


WHAT ARE THE SIDE EFFECTS?
Juluca is usually very well tolerated. The most commonly reported side effects seen among people taking it are headache and diarrhea.

When you start any ART, you may have temporary side effects such as headaches, high blood pressure, or just feeling ill. These side effects usually get better or disappear over time.

The most common side effects of rilpivirine are depression, insomnia, headache, and rash. Be sure to discuss any side effects with your health care provider. Rilpivirine can cause liver damage. Be sure your health care provider knows if you have hepatitis B or C.

 


HOW DOES IT REACT WITH OTHER DRUGS?
Dolutegravir and rilpivirine can interact with other drugs or supplements that you are taking. These interactions can change the amount of each drug in your bloodstream and cause an under- or overdose. New interactions are being identified all the time.

Antacids that contain aluminum or magnesium and calcium or iron supplements should be taken 4 hours before or 6 hours after Juluca.

Juluca should not be taken with proton pump inhibitors, the tuberculosis drugs rifampin or rifapentine, the steroid dexamethasone, some seizure medications, or with St. John’s wort (see Fact Sheet 729).

Methadone doses do not need to be adjusted when taken with Juluca.

Make sure that your health care providers know about ALL drugs and supplements you are taking.

 


THE BOTTOM LINE
Juluca is the first complete two-drug HIV regimen. It can be taken by people who have been on treatment for 6 months, without history of treatment failure, and whose virus does not have drug resistance.
 


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