Rilpivirine
| Evidence Level: L4 | Predicted Indications: 5 |
Table of Contents
Rilpivirine: From HIV-1 Infection to Feline Acquired Immunodeficiency Syndrome
One-Sentence Summary
Rilpivirine is a non-nucleoside reverse transcriptase inhibitor (NNRTI) used to treat HIV-1 infection in people. The TxGNN model predicts it may be effective for Feline Acquired Immunodeficiency Syndrome (FIV infection in cats). The only supporting evidence is 1 preclinical publication and 0 clinical trials, and this is a veterinary indication, so it falls outside human drug repurposing.
Quick Overview
| Item | Content |
|---|---|
| Original Indication | HIV-1 infection (the SAHPRA indication text is not recorded in the source data) |
| Predicted New Indication | Feline acquired immunodeficiency syndrome |
| TxGNN Prediction Score | 99.97% |
| Evidence Level | L4 |
| South Africa Market Status | Marketed |
| Number of SAHPRA Registrations | 3 |
| Recommended Decision | Hold |
Why is This Prediction Reasonable?
Detailed mechanism of action data is not available in the source data. From its drug class, rilpivirine is an NNRTI that blocks HIV-1 reverse transcriptase (RT), and its efficacy in HIV-1 infection is established.
Feline immunodeficiency virus (FIV) is a lentivirus, like HIV, and it also relies on an RT enzyme. That makes the link plausible in principle. A 2023 biochemical and structural study compared the NNRTIs nevirapine, efavirenz and rilpivirine against feline and human immunodeficiency virus RT. Cats have no effective treatment for FIV, which is the gap this work addresses.
The very high TxGNN score most likely reflects how close FIV sits to HIV in the knowledge graph. It does not show that rilpivirine works against FIV. There are no veterinary efficacy or safety data, and no registered trials. Any use in cats would fall under veterinary regulation, not human medicine.
Clinical Trial Evidence
Currently no related clinical trials registered.
Literature Evidence
| PMID | Year | Type | Journal | Key Findings |
|---|---|---|---|---|
| 38031646 | 2023 | Preclinical (biochemical/structural, in vitro) | Journal of Veterinary Science | Compared nevirapine, efavirenz and rilpivirine against feline and human immunodeficiency virus RT to assess whether NNRTIs could treat FIV infection. The available abstract does not report quantitative results. |
South Africa Market Information
| Registration Number | Product Name | Dosage Form |
|---|---|---|
| Reg. No. 55/20.2.8/0301 | Daliduo | Film-coated tablet (Fct) |
| Reg. No. 56/20.2.8/0020 | Tavirant | Film-coated tablet (Fct) |
| Reg. No. 49/20.2.8/0399 | Erestz | Film-coated tablet (Fct) |
The SAHPRA records for these products do not include approved indication text or manufacturer names.
Safety Considerations
Please refer to the SAHPRA-approved Professional Information (PI) for safety information. Report adverse drug reactions to SAHPRA. No drug interaction records were found for this drug in the source data.
Conclusion and Next Steps
Decision: Hold
Rationale: The only evidence for feline AIDS is one in vitro biochemical and structural study, with no clinical trials and no animal efficacy or safety data. The indication is also veterinary, so it is not a human repurposing opportunity.
Other predictions for rilpivirine that are better supported and worth separate review:
- AIDS-related complex (Proceed with Guardrails): it overlaps with rilpivirine’s established HIV-1 use, so it is mostly an on-label confirmation.
- Congenital HIV (Proceed with Guardrails, L2): the main gap is direct evidence in pregnancy and paediatric populations.
- SIV infection in macaques: an animal model that supports the approved HIV-1 use, not a separate indication.
To proceed, the following is needed:
- A decision on whether veterinary indications are in scope for this programme
- Mechanism of action data from DrugBank
- The SAHPRA package insert, so warnings and contraindications can be extracted
- The approved indication text for the three SAHPRA registrations, to confirm the original indication
- For any feline use, in vivo efficacy and safety studies in FIV-infected cats
Disclaimer
This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.