In the US, a large number of pregnant HIV-positive women give birth each year. These women can successfully treat their condition to accomplish viral suppression at levels that can’t be detected and have a healthy conception, pregnancy, and vaginal birth.
Dolutegravir
A regimen consisting of Dolutegravir is favored as the first anti-retroviral therapy(ART) for pregnant HIV-positive individuals. The use of Dolutegravir is encouraged because it has fewer side effects, limits the emergence of resistance mutations in the event that a high viral load should return, and has great potency.
Getting insight into the effectiveness and safety of the medication has been achieved by comparing it to other ART medications, especially when administered before pregnancy. A new study did this, and the results have been looking quite favorable for Dolutegravir.
Other medications were proven to cause less frequent viral suppression
Data were collected from pregnant women who had HIV-1. Dolutegravir was compared to the following combinations darunavir–ritonavir, atazanavir–ritonavir, elvitegravir–cobicistat, rilpivirine, and raltegravir. 29 years old was the average age of conception, and 51% of the participants started ART before pregnancy.
According to the outcome, Dolutegravir participants had viral suppression at childbirth in 96.7% of their pregnancies, compared to 84.0% for atazanavir-ritonavir, 89.2% for raltegravir, and 89.8% for elvitegravir-cobicistat participants.
This shows that Dolutegravir is more effective for preventing increased viral load, even though it has the potential to cause neural tube defects. There were also some adjusted risks like low birth weight, preterm birth, and being small for gestational age. In the end, the best choice of drug is to be made by taking both the benefits and the risks of available drug regimens into consideration
Clinical significance
One very important finding was that reduced viral load at delivery was less frequent with other ARTs than with Dolutegravir. It is a very effective ART in pregnancy. Suppose women living with HIV who are pregnant or considering becoming pregnant are attentively involved and participate in decision-making about their antiretroviral medication. In that case, Dolutegravir should be regarded as an effective treatment option.
Conclusion
According to data, raltegravir and atazanavir-ritonavir offer less HIV viral suppression at delivery than Dolutegravir. Darunavir-ritonavir is a viable substitute for Dolutegravir when it is not practical to use it.
References
Zipursky, J., & Loutfy, M. (2020). Dolutegravir for pregnant women living with HIV. CMAJ, 192(9), E217–E218. https://doi.org/10.1503/cmaj.191227
