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While effective viral suppression with antiretroviral therapy has been proven to substantially reduce the risk of sexual transmissiona residual risk cannot be excludedPrecautions to prevent transmission should be taken in accordance with national guidelines.

The available pharmacokinetic data suggest that the concomitant use of rifampicin and nevirapine is not recommendedFurthermorecombining the following compounds with Viramune is not recommendedefavirenzketoconazoledelavirdineetravirinerilpivirineelvitegravirin combination with cobicistatatazanavirin combination with ritonavirboceprevirfosamprenavirif not co-administered with low dose ritonavirsee section 4.5

Data on the effectiveness of nevirapine in subsequent regimens are limitedSubsequent regimens using NNRTIs appear most effective in individuals who have not previously experienced virologic failure while using drugs of this class.

Immune Reactivation SyndromeIn HIV-infected patients with severe immune deficiency at the time of institution of combination antiretroviral therapyCARTan inflammatory reaction to asymptomatic or residual opportunistic pathogens may arise and cause serious clinical conditionsor aggravation of symptomsTypicallysuch reactions have been observed within the first few weeks or months of initiation of CARTRelevant examples are cytomegalovirus retinitisgeneralised and/or focal mycobacterial infectionsand Pneumocystis jirovecii pneumoniaAny inflammatory symptoms should be evaluated and treatment instituted when necessaryAutoimmune disorderssuch as Gravesdiseasehave also been reported to occur in the setting of immune reactivationhoweverthe reported time to onset is more variable and these events can occur many months after initiation of treatment.

No clinical data availableDue to the metabolic pathway of raltegravir no interaction is expected.

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