Principles of Antiretroviral Therapy Management

[@KaraboJMotaung]

The 2018 study in Botswana published in the New England Journal of Medicine, reported a potentially increased risk of neural tube defects (NTDs) in infants born to women taking dolutegravir (DTG) during pregnancy should not deter women from taking DTG in pregnancy as subsequent studies and analyses have found no significant increased risk of NTDs or other birth defects associated with DTG use during pregnancy.
The initial study's findings were likely due to:
1. Small sample size: The study had a limited number of participants, which can lead to statistical fluctuations.
2. Confounding variables: Other factors, such as folic acid supplementation and pre-existing medical conditions, may have influenced the results.
3. Selection bias: The study's design may have inadvertently selected women with higher risk profiles.
Subsequent studies, including:
1. The DolPHIN-2 study (2019): Found no increased risk of NTDs or other birth defects with DTG use during pregnancy.
2. The IMPAACT 2016 study (2020): Showed no significant difference in birth defects between DTG and efavirenz (EFV) treatment groups.
3. The WHO-sponsored study (2020): Found no increased risk of NTDs or other birth defects with DTG use during pregnancy.
These studies, along with others, have led to the conclusion that DTG is safe to use during pregnancy, and it is now recommended as a preferred antiretroviral therapy (ART) option for pregnant women living with HIV by:
1. WHO (2019)
2. US DHHS (2020)
3. European AIDS Clinical Society (2020)
It is however, essential to note that all medications should be used under the guidance of a healthcare professional, and pregnant women living with HIV should discuss their treatment options with their provider.