Dolutegravir-Based Antiretroviral Therapies for HIV-1 Effective in Pregnancy
First study to directly compare dolutegravir to other commonly used antiretroviral regimens in pregnancy found that dolutegravir-based regimens had a high probability of viral suppression at delivery
Dolutegravir-based antiretroviral therapy (ART) for HIV-1 infection is more effective in pregnancy than some other ART regimens commonly used in the U.S. and Europe, according to a study published in the New England Journal of Medicine.
“Our study showed that dolutegravir-based regimens had a high probability of maternal viral suppression at delivery, and there were no observable differences in the risks of adverse birth outcomes, such as preterm birth, low birth weight, small for gestational age, or neonatal death, between dolutegravir and the other contemporary regimens,” said co-author Ellen Chadwick, MD, Director of Section of Pediatric, Adolescent and Maternal HIV Infection at Ann & Robert H. Lurie Children’s Hospital of Chicago and Professor of Pediatrics at Northwestern University Feinberg School of Medicine. “This is great news, since dolutegravir also has other important benefits compared to older antiretroviral drugs.”
Dolutegravir, a more recently approved antiretroviral drug, is taken once-a-day, is more tolerable, and is less likely to result in resistance mutations compared with other antiretroviral drugs.
“This is one of the largest studies to examine the effectiveness and safety of dolutegravir in pregnancy compared to regimens that have been commonly used during pregnancy in the U.S. and Europe,” said co-author Jennifer Jao, MD, MPH, an infectious diseases physician at Lurie Children’s and Associate Professor of Pediatrics at Northwestern University Feinberg School of Medicine. “Our results show viral suppression at delivery in considerably more participants.”
In the current observational study, the researchers compared dolutegravir-based ART in pregnancy to atazanavir/ritonavir-, darunavir/ritonavir-, and raltegravir-based regimens that are currently classified by the Department of Health and Human Services Guidelines Panel as “Preferred” for use in pregnancy in the U.S. About half of the participants started ART before conception. At delivery, 96.7 percent of the pregnancies in participants who received dolutegravir had viral suppression, whereas atazanavir/ritonavir and raltegravir had viral suppression rates of 84 percent and 89.2 percent, respectively.
This research was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, National Institute of Dental and Craniofacial Research, National Institute of Allergy and Infectious Diseases, National Institute of Neurological Disorders and Stroke, National Institute on Deafness and Other Communication Disorders, National Institute of Mental Health, National Institute on Drug Abuse, National Cancer Institute, National Institute on Alcohol Abuse and Alcoholism, National Heart, Lung, and Blood Institute (grants HD052102 and HD052104), and Harvard Chan School for PHACS 2020 (P01HD103133), and the Swiss National Science Foundation (grant 201369).
Research at Ann & Robert H. Lurie Children’s Hospital of Chicago is conducted through Stanley Manne Children’s Research Institute. The Manne Research Institute is focused on improving child health, transforming pediatric medicine and ensuring healthier futures through the relentless pursuit of knowledge. Lurie Children’s is ranked as one of the nation’s top children’s hospitals by U.S. News & World Report. It is the pediatric training ground for Northwestern University Feinberg School of Medicine.