Dr KK Aggarwal
(WHO, July 22, 2019): Based on
new evidence assessing benefits and risks, the WHO recommends the use of the
HIV drug dolutegravir (DTG) as the preferred first-line and second-line
treatment for all populations, including pregnant women and those of
childbearing potential.
Initial studies had
highlighted a possible link between DTG and neural tube defects (birth defects
of the brain and spinal cord that cause conditions such as spina bifida) in
infants born to women using the drug at the time of conception. This potential
safety concern was reported in May 2018 from a study in Botswana that found 4
cases of neural tube defects out of 426 women who became pregnant while taking
DTG. Based on these preliminary findings, many countries advised pregnant women
and women of childbearing potential to take efavirenz (EFV) instead.
New data from two large
clinical trials comparing the efficacy and safety of DTG and EFV in Africa have
now expanded the evidence base. The risks of neural tube defects are
significantly lower than what the initial studies may have suggested.
DTG is a drug that is more
effective, easier to take and has fewer side effects than alternative drugs
that are currently used. DTG also has a high genetic barrier to developing drug
resistance, which is important given the rising trend of resistance to EFV and
nevirapine-based regimens.
In 2019, 12 out of 18
countries surveyed by WHO reported pre-treatment drug resistance levels
exceeding the recommended threshold of 10%.
Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of
Medical Associations in Asia and Oceania
(CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of
India
Past National President
IMA
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