Reviewed by: HU Medical Review Board | Last reviewed: 5/31/22

Juluca is a combination medication that contains dolutegravir and rilpivirine. It is used as a standalone antiretroviral therapy (ART) regimen for HIV-1 in adults who are replacing a stable ART regimen, have not had any previous treatment failures, and who have had a viral load (amount of HIV in the blood) of 50 copies per mL or less on a stable ART regimen for at least six months.

Although it is not a cure for HIV, when taken as directed, it allows for the virus to be suppressed. This prevents further transmission of HIV and allows an individual’s immune system to improve through increasing CD4 cell counts and decreasing viral load.

What are the ingredients in Juluca?

The main ingredients in Juluca are dolutegravir and rilpivirine. Rilpivirine is a non-nucleoside reverse transcriptase inhibitor (NNRTI), while dolutegravir is an integrase strand transfer inhibitor (INSTI, also known as an integrase inhibitor).

How does Juluca work?

Juluca is a combination of an NNRTI medication and an integrase inhibitor. NNRTIs stop the reverse transcription step of the HIV life cycle. Normally, HIV uses its reverse transcriptase enzyme to build a strand of DNA from its original RNA form. In order to do this, it uses genetic building blocks called nucleosides that come from the host cell. These nucleosides are strung together one at a time, like beads on a string, to create the final DNA product.

How do NNRTIs work?

NNRTIs bind to the reverse transcriptase enzyme itself to stop the DNA-building process. When an NNRTI binds to reverse transcriptase, the enzyme is unable to attach more nucleosides to the chain. This prevents HIV RNA from making it all the way through the reverse transcription process and into host DNA for further replication.

How do integrase inhibitors work?

After HIV RNA is reverse transcribed into newly-formed DNA, it gets integrated into the host cell DNA using an enzyme called integrase. This allows HIV to be actively replicated with the rest of our DNA as our cell carries out its normal functions. Integrase inhibitors can be used to block the integrase enzyme and prevent the integration of HIV DNA into our host cells. If HIV’s DNA cannot be inserted into our host cells’ genome, the virus cannot continue to be replicated, assembled into mature virus particles, and released into the blood to continue infecting other cells.

Possible side effects

The most common side effects of Juluca include, but are not limited to:

  • Diarrhea
  • Headache
  • Nausea

Things to consider

As with any medication, there are several very rare but serious risks that need to be considered before taking Juluca. Your healthcare provider can help determine what issues you may be at risk for and help determine what treatment options are the safest for you. It’s also important to remember that the risk of one or more of these issues occurring is low, and the benefits of treating the virus often greatly outweigh the risks.

Several of these rare but serious side effects of Juluca include liver issues, especially for those with a history of hepatitis B or C virus. Signs of liver issues include, but are not limited to:

  • Dark-colored urine
  • Loss of appetite
  • Nausea
  • Yellowing of the whites of the eyes or skin
  • Light-colored bowel movements
  • Pain or tenderness on the right side of your stomach

Rarely, serious psychiatric issues such as depression or mood changes may occur. Contact your healthcare provider as soon as possible if you experience these or have any suicidal thoughts or ideations.

These are not all the possible side effects of Juluca. Patients should talk to their doctor about what to expect with treatment with Juluca.

Before starting Juluca, tell your doctor if you:

  • Have or previously had hepatitis B virus
  • Have or previously had hepatitis C virus
  • Have a history of liver problems
  • Have ever had an allergic reaction or skin rash after taking medicines that contain rilpivirine or dolutegravir
  • Have a history of a mental condition, depression, or suicidal thoughts
  • Are pregnant or planning to become pregnant (pregnancy testing is recommended before starting therapy as Juluca can cause fetal harm)
  • Are breastfeeding or planning to breastfeed
  • Are taking any over-the-counter vitamins, supplements, medicines, or herbal remedies
  • Are on any other medications or are about to start any other medications, including hormonal birth control or medications for hepatitis viruses

Juluca cannot be taken with certain medications, including a medication called dofetilide. It is important to tell your doctor about any and all medications you are taking to ensure you are taking Juluca safely.

On rare occasions, skin rashes or allergic reactions may occur with Juluca and may be serious. Alert your healthcare provider if you notice any of the following:

  • Skin blisters or peeling
  • Mouth sores
  • Swelling of the lips, mouth, face, or throat
  • Fever
  • Trouble breathing or swallowing
  • Redness or swelling of the eyes
  • Generally feeling ill
  • Tiredness
  • Muscles or joint aches

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