skip to main content

Rilpivirine-PPI Interaction — SCE Infectious Diseases MCQ

Instant feedback + full explanation. One question, done properly.

EasyHIV MedicineRilpivirine-PPI InteractionSCE Infectious Diseases

A 40-year-old man with HIV on ART (CD4 520, VL <50) is co-prescribed Omeprazole 20 mg daily for GORD. He is on Rilpivirine/TAF/FTC (Odefsey). Why is this combination problematic?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Proton pump inhibitors significantly reduce Rilpivirine absorption (Rilpivirine requires gastric acid for absorption) — PPIs are contraindicated with Rilpivirine

Rilpivirine requires an acidic gastric pH for adequate absorption. Proton pump inhibitors raise gastric pH, reducing Rilpivirine bioavailability by ~40%. PPIs are therefore absolutely contraindicated with Rilpivirine-containing regimens. H2-receptor antagonists can be used cautiously (must be taken ≥12 hours before or ≥4 hours after Rilpivirine). If a PPI is essential, the ART should be switched to a non-Rilpivirine regimen. This is one of the most commonly tested ART drug interactions.

Reference: BHIVA 2025 – ART guidelines; BNF 2024 – Rilpivirine; Liverpool Drug Interactions