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  • 1.  Oral semaglutide with FTC/RPV/TAF

    Posted 21 days ago

    I have a patient on FTC/RPV/TAF for HIV management who has been undetectable since 2017 on this regimen and no indication to change treatment given long-term stability. Patient has been on injectable semaglutide for weight management previously and did well with no disruption to HIV control while on FTC/RPV/TAF and injectable semaglutide. Now insurance is no longer covering injectable semaglutide and we are possibly pursuing oral semaglutide as a cheaper alternative for the patient. With potential absorption concerns of rilpivirine with a patient on semaglutide, I am curious if anyone has experience with this? I recognize there are limited studies (to my knowledge) regarding this specific scenario. Any insights are appreciated. 

    Thanks!

    Ryan



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    Ryan K. Doyle, DO (he/him/his)
    rymed89@gmail.com
    Grand Rapids, MI
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  • 2.  RE: Oral semaglutide with FTC/RPV/TAF

    Posted 20 days ago

    There is a theoretical risk with oral semaglutide, since it can lower gastric acid secretion, which could potentially interfere with RPV absorption. The Liverpool HIV Drug Interaction site says, "Consider taking rilpivirine 4 hours before orally administered semaglutide. Note: food, beverages and oral medicinal products can interfere with the absorption of oral semaglutide. Therefore, patients must wait at least 30 minutes after taking oral semaglutide before taking any other oral medicinal product."

    I suppose you could do all that, but it might be easier to just switch to a regimen such as BIC/FTC/TAF, where you don't have to worry about the possible interactions. You'll also be switching to a regimen with a higher barrier to resistance and no food restrictions.



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    Joel Gallant, MD, MPH
    Johns Hopkins University
    Baltimore, MD

    AXCES Research Group
    Santa Fe, NM
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    Original Message


  • 3.  RE: Oral semaglutide with FTC/RPV/TAF

    Posted 13 days ago

    Joel, 

    Thank you for the reply. I had very similar thoughts! I offered to my patient the option of switching to Biktarvy. My patient found a way to get the injectable covered again and given he remained virally suppressed in the past while taking injectable semaglutide, it seems reasonable to keep the same regimen for now. 

    Thanks again!

    Ryan



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    Ryan K. Doyle, DO (he/him/his)
    rymed89@gmail.com
    Grand Rapids, MI
    ------------------------------

    Original Message


  • 4.  RE: Oral semaglutide with FTC/RPV/TAF

    Posted 20 days ago
    No personal experience. According to Liverpool, most prudent would be separate by 4 hours. If impossible, would monitor.


    Original Message


  • 5.  RE: Oral semaglutide with FTC/RPV/TAF

    Posted 20 days ago

    Hi Ryan,

    In terms of absorption concerns with GLP1 RAs, I don't think there will be much of a difference in terms of changes in gut transit with oral versus injectable semaglutide.  I did read that GLP1RAs can reduce stomach acid production (I did not know that).   Since oral rilpivirine requires an acid environment for adequate absorption, this might be a concern.  Until now, he seems to have maintained viral suppression.  But, this might reduce his margin for error, especially if something in the future affects his adherence.  So, might be best to change to something that is not dependent on stomach acid secretion, such as Biktarvy or Dovato.   That would be my thinking. Thanks.



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    Adam Zweig
    San Diego CA
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    Original Message


  • 6.  RE: Oral semaglutide with FTC/RPV/TAF

    Posted 13 days ago

    Adam, 

    Agree, thank you! My patient found a way to get injectable semaglutide covered, so we are going to stay with that for now since he has remained virally suppressed. If he chooses or needs to switch to oral semaglutide in future, I would consider offering him a switch to Biktarvy (I did already offer him this option if he moved forward with oral semaglutide). 

    Thanks again!

    Ryan



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    Ryan K. Doyle, DO, FAAFP, AAHIVS
    He/Him/His
    rymed89@gmail.com
    Grand Rapids, MI
    ------------------------------

    Original Message


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