Dolutegravir-based regimen more effective for treating pregnant women with HIV-1

Dolutegravir-based regimen more effective for treating pregnant women with HIV-1

Dolutegravir-based antiretroviral therapies (ART) for HIV-1 are more effective for pregnant women than some other ART regimens commonly used in the United States and Europe, according to a study led by researchers at the Harvard TH Chan School of Public Health.

The study, published online September 1, 2022, in NEJM, showed that pregnant women taking dolutegravir-based regimens were more likely to have viral suppression at delivery. No differences in the risks of adverse birth outcomes (preterm birth, low birth weight, small for gestational age, or neonatal death) were observed between dolutegravir-based regimens and the other current regimens.

"A dolutegravir-based regimen is currently recommended worldwide for the treatment of HIV, and this is the first study to directly compare regimens containing dolutegravir with other antiretroviral regimens, such as."

Kunjal Patel, Senior Research Scientist, Department of Epidemiology, Harvard Chan School and lead author of the study

Dolutegravir, a recently approved antiretroviral drug, is part of a once-daily regimen that has been shown to be more effective, easier to tolerate, and less likely to induce new drug resistance in people with HIV-1 compared to other antiretroviral drugs. However, there are limited data on its effectiveness and safety in pregnancy compared to regimens commonly used during pregnancy in the United States and Europe.

In the current observational study, researchers compared the use of dolutegravir in pregnancy with antiviral regimens of atazanavir/ritonavir, darunavir/ritonavir, and raltegravir, which are currently considered "preferred" for use in pregnancy in the United States. About half of the participants started ART before conception. At delivery, 96.7% of the pregnancies of participants taking dolutegravir were virally suppressed, while those of participants taking atazanavir/ritonavir or raltegravir had 84.0% and 89.2% viral suppression, respectively.

"We believe the differences observed are due to dolutegravir's ability to rapidly reduce viral load and its ease of use as part of a once-daily regimen available as a fixed-dose combination," Patel said. “Our results highlight the continued need for systematic studies that compare new antiretroviral therapies with those already in clinical practice to help inform the development of guidelines and clinical practice over time.”

Source:

Harvard TH Chan School of Public Health

Reference:

Patel, K., et al. (2022) Dolutegravir in Pregnancy Compared to Current HIV Therapies in the United States. The New England Journal of Medicine. doi.org/10.1056/NEJMoa2200600.

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