International AIDS Conference
International AIDS Conference
Perspective from Monica Gandhi, MD, MPH
Source/Disclosures
Source:

Asif SF, et al. Faster virological suppression with dolutegravir versus efavirenz in pregnancy does not lower the risk of HIV mother-to-child transmission: A meta-analysis of 5 clinical trials in 1074 pregnant women. Presented at: International AIDS Conference; July 6-10, 2020 (virtual meeting).

Disclosures: Healio could not confirm relevant financial disclosures at the time of publication.
July 13, 2020
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Pregnant women on dolutegravir experience better HIV viral suppression rates vs. efavirenz

Perspective from Monica Gandhi, MD, MPH
Source/Disclosures
Source:

Asif SF, et al. Faster virological suppression with dolutegravir versus efavirenz in pregnancy does not lower the risk of HIV mother-to-child transmission: A meta-analysis of 5 clinical trials in 1074 pregnant women. Presented at: International AIDS Conference; July 6-10, 2020 (virtual meeting).

Disclosures: Healio could not confirm relevant financial disclosures at the time of publication.
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The results of five randomized controlled trials showed greater and faster rates of virologic suppression among pregnant women with HIV who took dolutegravir compared to those who took efavirenz, researchers reported at AIDS 2020.

However, this did not translate to a lower risk for vertical transmission, according to a meta-analysis of the studies by Sumbal Fatima Asif, PhD, of Imperial College London, and colleagues.

Rates of viral suppression among pregnant mothers
Rates of viral suppression among pregnant mothers.

The studies assessed primary and secondary outcomes among 1,074 pregnant women taking either dolutegravir or efavirenz. Primary endpoints included viral suppression, number of stillbirths, neonatal deaths and vertical transmission. Secondary endpoints included the total number of mother and infants experiencing one or more adverse events, preterm births and small-for-gestational-age infants.

Last year, WHO strengthened its recommendation for dolutegravir as a first-line treatment for HIV in all populations — including pregnant women — after data from the Tsepamo study showed a lower prevalence of neural tube defects among infants born to mothers taking dolutegravir than previously reported.

According to Asif and colleagues, their analysis showed significant differences only in preterm births and viral suppression rates. The risk for preterm birth was 4% higher in women using efavirenz (RD = -0.04, 95% CI, -0.07 to 0), and the odds of viral suppression were almost three times higher in women using dolutegravir (OR = 2.90, 95% CI, 1.54-5.46).

No significant differences were found between treatment groups in regard to mother-to-child-transmission. Five total cases of mother-to-child-transmission were reported, among women taking dolutegravir.