Breakthrough As WHO Certifies New HIV Treatment Drug For Pregnant Women

An antiretroviral drug Dolutegravir, commonly known as DTG, has been certified safe for use by pregnant women and those in their reproductive years by the World Health Organisation (WHO).

Though initial research linked the drug with neural tube defects (NTDs) in infants born to women using dolutegravir at the time of conception, recent studies have shown that it is far more tolerable than the older drug Efavirenz, which patients have reported to have caused depression and hallucinations in the first few months and could lead to people not staying on treatment. The organisation states:

“DTG is a drug that is more effective, easier to take and has fewer side effects than alternative drugs that are currently used. DTG also has a high genetic barrier to developing drug resistance, which is important given the rising trend of resistance to efavirenz and nevirapine-based regimens.”

The study looked at more than 119 000 deliveries between August 2014 and April 2019, including close to 1 700 among women who were taking dolutegravir at the time they fell pregnant.

Researchers found that NTDs occurred in three per 1 000 deliveries among women on dolutegravir-based treatment, as compared to one per 1 000 deliveries among women taking other ARV drugs.

The Brazil study included 1 468 women who became pregnant while on ARV treatment, with 392 taking DTG at the time of conception.

Researchers found no cases of birth defects occurred, which backs up the conclusion that even if DTG-based therapy is associated with a risk of NTD, the risk remains quite low. WHO’s HIV testing and prevention, Dr Rachel Baggaley, said:

“Our recommendations indicate that one could [see] the benefits of taking DTG as first-line treatment outweighs the harm. We should have an individual discussion with every young woman, especially if she’s interested in becoming pregnant, about her understanding of those potential, yet small and real risk of neural tube defects. And she could consider taking another drug if she felt that that was beneficial for her.”
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WHO in a statement shared on its official website on Monday, said that the DTG drug is now more effective, easier to take and has fewer side effects than alternative drugs that are currently used.

“DTG also has a high genetic barrier to developing drug resistance, which is important given the rising trend of resistance to EFV and nevirapine-based regimens. In 2019, 12 out of 18 countries surveyed by WHO reported pre-treatment drug resistance levels exceeding the recommended threshold of 10 per cent.

All of above findings informed the decision to update the 2019 guidelines, and the newly updated recommendations aim to help more countries improve their HIV policies.

For any medications, informed choice is important as every treatment decision needs to be based on an informed discussion with the health provider weighing the benefits and potential risks.”