What is the role of dolutegravir (DTG) in antiretroviral therapy (ART) for pregnant women with HIV infection?

Updated: Jun 23, 2020
  • Author: Madhu Chhanda Choudhary, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Answer

Dolutegravir (DTG) appears to be safe if started in pregnancy; however, there are concerns of preconception safety signal. The TSEPAMO study in Botswana reported neural tube defects in 4 of 426 (0.9%) babies born to women who were taking dolutegravir at the time they became pregnant, compared with a 0.1% occurrence in babies born to women who were not taking dolutegravir. [20] In an updated analysis of the TSEPAMO study, among the 1,683 deliveries in which the mother was taking dolutegravir-based ART at conception, five neural-tube defects were found (0.30% of deliveries; 95% CI, 0.13 to 0.69), compared with 15 defects among 14,792 deliveries (0.10%; 95% CI, 0.06 to 0.17) in mothers receiving non-dolutegravir ART at conception. [21] Zero neural tube defects were reported in 2,812 infants (95% CI: 0 to 0.13) born to mothers who started DTG during pregnancy. [11] Therefore, a dolutegravir-based regimen is now preferred for ART initiation during pregnancy and an alternative regimen in women of childbearing potential with counseling and shared decision-making between the clinician and patient. [1]


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