Dolutegravir-based regimens in the post-partum period.

The introduction of antiretroviral therapy (ART) during pregnancy represents one of the most important achievements of the public health response to the HIV epidemic. However, the absence of safety and efficacy data for many ART regimens in pregnant and post-partum women remains a concern. Indeed, in interim WHO HIV treatment guidelines from 2018, which recommended a transition from efavirenz to dolutegravir in first-line regimens, the absence of definitive pregnancy-related safety and efficacy evidence was highlighted. 1 WHOUpdated recommendations on first-line and second-line antiretroviral regimens and post-exposure prophylaxis and recommendations on early infant diagnosis of HIV: interim guidelines: supplement to the 2016 consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. https://apps.who.int/iris/handle/10665/277395Date: 2018 Date accessed: April 13, 2023 Google Scholar Thereafter, much needed data from randomised trials in women initiating ART in pregnancy, comparing efavirenz-containing and dolutegravir-containing regimens, came from the DolPHIN-2 and IMPAACT 2010/VESTED trials, 2 Kintu K Malaba TR Nakibuka J et al. Dolutegravir versus efavirenz in women starting HIV therapy in late pregnancy (DolPHIN-2): an open-label, randomised controlled trial. Lancet HIV. 2020; 7: e332-e339 Summary Full Text Full Text PDF PubMed Scopus (47) Google Scholar , 3 Lockman S Brummel SS Ziemba L et al. Efficacy and safety of dolutegravir with emtricitabine and tenofovir alafenamide fumarate or tenofovir disoproxil fumarate, and efavirenz, emtricitabine, and tenofovir disoproxil fumarate HIV antiretroviral therapy regimens started in pregnancy (IMPAACT 2010/VESTED): a multicentre, open-label, randomised, controlled, phase 3 trial. Lancet. 2021; 397: 1276-1292 Summary Full Text Full Text PDF PubMed Scopus (49) Google Scholar supporting updated 2019 treatment guidelines. 4 WHOUpdate of recommendations on first- and second-line antiretroviral regimens. https://www.who.int/publications/i/item/WHO-CDS-HIV-19.15Date: July 17, 2019 Date accessed: April 13, 2023 Google Scholar Efficacy and safety of three antiretroviral therapy regimens started in pregnancy up to 50 weeks post partum: a multicentre, open-label, randomised, controlled, phase 3 trialSafety and efficacy data during pregnancy and up to 50 weeks post partum support the current recommendation of dolutegravir-based ART (particularly in combination with emtricitabine and tenofovir alafenamide) rather than efavirenz, emtricitabine, and tenofovir disoproxil fumarate, when started in pregnancy. Full-Text PDF