Dolutegravir Compared With Other Regimens for HIV in Pregnancy

THURSDAY, Sept. 1, 2022 (HealthDay News) -- HIV-1 viral suppression at delivery is less frequent with atazanavir-ritonavir and raltegravir than dolutegravir during pregnancy, according to a study published in the Sept. 1 issue of the New England Journal of Medicine.

Kunjal Patel, D.Sc., from the Harvard T.H. Chan School of Public Health in Boston, and colleagues conducted a study involving pregnancies in persons with HIV-1 infection whose initial antiretroviral therapy (ART) in pregnancy included dolutegravir (120 participants), atazanavir-ritonavir (464 participants), darunavir-ritonavir (185 participants), oral rilpivirine (243 participants), raltegravir (86 participants), or elvitegravir-cobicistat (159 participants). Between each non-dolutegravir-based ART regimen and dolutegravir-based ART, viral suppression at delivery and the risks of infants being born preterm, having low birth weight, and being small for gestational age were compared.

Fifty-one percent of the pregnancies were in participants who started ART prior to conception. The researchers found that viral suppression was present at delivery in 96.7 percent of those who received dolutegravir, and in 84.0, 89.2, and 89.8 percent of those who received atazanavir-ritonavir, raltegravir, and elvitegravir-cobicistat, respectively. The risks of preterm birth varied from 13.6 to 17.6 percent. No significant difference was seen for non-dolutegravir-based ART and dolutegravir in terms of the adjusted risks of infants being born preterm, having low birth weight, or being small for gestational age.

"Our results provide evidence suggesting that atazanavir-ritonavir and raltegravir provide less HIV viral suppression at delivery than dolutegravir and support darunavir-ritonavir as a reasonable alternative when dolutegravir use is not feasible," the authors write.

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