Risk for neural tube defects offset by fewer deaths among women, decreased sexual HIV transmission
TUESDAY, April 2, 2019 (HealthDay News) — Dolutegravir should be considered for antiretroviral therapy (ART) in treating HIV in women of childbearing potential in resource-limited settings, despite its associated risk for neural tube defects, according to a study published online April 2 in the Annals of Internal Medicine.
Caitlin M. Dugdale, M.D., from Massachusetts General Hospital in Boston, and colleagues developed a model to project clinical outcomes of three ART policies for 3.1 million South African women with HIV (aged 15 to 49 years) starting or continuing first-line ART and their children. The three strategies included: efavirenz for all women of childbearing potential (EFV), dolutegravir for all women of childbearing potential (DTG), or World Health Organization (WHO)-recommended efavirenz without contraception or dolutegravir with contraception (WHO approach).
The researchers found that compared with EFV, DTG averted 13,700 women’s deaths (0.44 percent decrease) and 57,700 sexual HIV transmissions but increased total pediatric deaths by 4,400 because of more neural tube defects. Compared with EFV, the WHO approach offered some benefits by averting 4,900 women’s deaths and 20,500 sexual transmissions, with 300 pediatric deaths. With DTG, combined deaths among women and children were lowest versus the WHO approach or EFV (358,000 deaths versus 362,800 and 367,300 deaths, respectively).
“These results argue against a uniform policy of avoiding dolutegravir in women of childbearing potential,” the authors write.
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