Use of Liraglutide for obesity in HIV. A case report

Background: Obesity is a complex, chronic, relapsing condition and is one of the greatest contributing factors to chronic disease burden in our society. It is also well-known that weight gain after antiretroviral treatment (ART) initiation can occur among people living with HIV and can occur with most antiretroviral classes. We report the case of a drug interaction involving Liraglutide and Rilpivirine, which resulted in an increased HIV viral load with risk of ongoing transmission Case presentation A young HIV positive Caucasian woman with excellent adherence to ART experienced weight gain during her pregnancy. This weight gain increased when she was switched to Tenofovir Alafenamide 25mg / Emtricitabine 200 mg / Bictegravir 50 mg. She was unable to lose weight despite a calorie-restricted diet and a regular exercise regimen. To avoid second generation integrase inhibitors (INSTI) she was treated with Tenofovir Alafenamide 25mg/Emtricitabine 200mg/Rilpivirine 25mg. She consulted her general practitioner to obtain weight reducing agents. She was prescribed Liraglutide, the daily injectable Glucagon-Like-Peptide (GLP)-agonist known to have weight loss properties. However, due to sub-optimal absorption of Rilpivirine through pharmacokinetic (PK) interactions of Rilpivirine and Liraglutide, our patient lost HIV virologic control and had breakthrough viraemia with risk of HIV transmission to her husband. Conclusions: Potentially serious adverse effects stemming from drug interactions involving medications used in clinical practice can occur, leading to loss of HIV virologic control.