Juluca is a two-drug, single-tablet HIV regimen for adults who are virologically stable, meaning their HIV viral load is already undetectable on their current treatment.

It combines:

• Dolutegravir: an integrase inhibitor that blocks HIV from inserting its genetic material into human cells
• Rilpivirine: a non-nucleoside reverse transcriptase inhibitor (NNRTI) that blocks a key enzyme HIV needs to copy its genetic material

Juluca is a simplification strategy. Rather than three or four antiretroviral drugs, patients switch to this two-drug tablet, maintaining viral suppression with fewer medicines.

Take one tablet once daily with a full meal. Food is essential for rilpivirine absorption: taking it on an empty stomach reduces the amount absorbed, which could compromise viral suppression.

Do not stop without speaking to your HIV doctor.

If you remember within 12 hours of your usual dose time, take it with food immediately. If more than 12 hours have passed, skip that dose and take the next one as scheduled. Never take two doses at once.

Contact your HIV specialist or a poison control centre immediately.

• Store below 30°C
• Keep in the original blister pack to protect from moisture and light
• Keep out of reach of children

Common side effects:

• Headache
• Nausea
• Dizziness
• Insomnia and abnormal dreams (more common with rilpivirine)
  

Important side effects:

• Depression and mood changes: rilpivirine-containing regimens are associated with a higher rate of mood disturbances. Report any new or worsening depression or anxiety
• Hypersensitivity reactions (dolutegravir): rash with systemic symptoms requires stopping immediately

Regular blood tests including viral load, kidney function, and liver function are part of routine HIV care.

Juluca has important interactions from both components:

• Antacids, calcium, iron, multivitamins: can bind to dolutegravir and reduce its absorption. Timing around your dose matters, so worth discussing with your pharmacist if you take these regularly
• Proton pump inhibitors (omeprazole, pantoprazole): can reduce rilpivirine absorption significantly. Discuss with your HIV doctor before combining
• Rifampicin, carbamazepine, phenytoin, phenobarbital, St John's Wort: dramatically reduce drug levels and cannot be used with Juluca
• Metformin: dolutegravir can raise metformin levels. Let your doctor know so they can keep an eye on it

Always check for interactions before starting any new medicine while on Juluca, including over-the-counter products and supplements.

Who is Juluca suitable for?

Juluca is a switch option, not a starter regimen. It is designed for adults who are already on stable HIV treatment with an undetectable viral load and have no history of treatment failure on NNRTIs or integrase inhibitors. Your HIV doctor will review your treatment history and resistance profile before switching.

Is two drugs enough to suppress HIV?

Yes, in the right patients. Multiple large clinical trials have shown that Juluca maintains viral suppression as effectively as three-drug regimens in people who are already virologically stable. The advantage is reducing the number of medicines, which may lower the risk of long-term side effects.

Ace provides accurate and independent information medically reviewed on prescription medications. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment.