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• W4288032947 abstract "Strategies to eliminate the perinatal transmission of HIV include initiation of effective antiretroviral therapy (ART) as soon as possible before or during pregnancy and maintaining a suppressed viral load throughout pregnancy and postpartum. Late initiation of ART in pregnant women with HIV has been associated with increased risk of perinatal transmission and perinatal mortality in infants. 1 Meyers K Qian H Wu Y et al. Early initiation of arv during pregnancy to move towards virtual elimination of mother-to-child-transmission of HIV-1 in Yunnan, China. PLoS One. 2015; 10e0138104 Crossref Scopus (17) Google Scholar In the DolPHIN-2 study, 2 Kintu K Malaba TR Nakibuka J et al. Dolutegravir versus efavirenz in women starting HIV therapy in late pregnancy (DolPHIN-2): an open-label, randomised controlled trial. Lancet HIV. 2020; 7: e332-e339 Summary Full Text Full Text PDF PubMed Scopus (40) Google Scholar 268 pregnant women with HIV (median gestational age 31 weeks) from Cape Town, South Africa and Kampala, Uganda, were enrolled and randomly assigned to receive either dolutegravir-based or efavirenz-based ART. The women were followed up at intervals to measure safety, the primary efficacy endpoint of a viral load less than 50 copies per mL when they gave birth, and the secondary efficacy endpoint of a viral load of more than 1000 copies per mL when they gave birth. In an interim analysis of data collected up to 14 days after birth (median duration of follow-up 55 days), Kintu and colleagues 2 Kintu K Malaba TR Nakibuka J et al. Dolutegravir versus efavirenz in women starting HIV therapy in late pregnancy (DolPHIN-2): an open-label, randomised controlled trial. Lancet HIV. 2020; 7: e332-e339 Summary Full Text Full Text PDF PubMed Scopus (40) Google Scholar reported that dolutegravir was associated with a 65% higher probability of a viral load less than 50 copies per mL in a shorter time compared with the efavirenz group (median 28 days vs 82 days). More pregnant women with HIV in the dolutegravir group (93·3%; median time 7 days) had a viral load of less than 1000 copies per mL compared with the efavirenz group (82·1%; median time 23 days). In the interim analysis, three perinatal transmissions, all in the dolutegravir group were reported. In a final analysis, published in The Lancet HIV, Thokozile R Malaba and colleagues 3 Malaba TR Nakatudde I Kintu K et al. 72 weeks post-partum follow-up of dolutegravir versus efavirenz initiated in late pregnancy (DolPHIN-2): an open-label, randomised controlled study. Lancet HIV. 2022; 9: e534-e543 Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar present efficacy and safety results from extended follow-up of the same pregnant women with HIV up to 72 weeks postpartum. 72 weeks post-partum follow-up of dolutegravir versus efavirenz initiated in late pregnancy (DolPHIN-2): an open-label, randomised controlled studyDolutegravir was safe and well tolerated, supporting updated WHO treatment recommendations in pregnant and breastfeeding women. Infant HIV transmissions can occur during breastfeeding despite persistently undetectable maternal viral load highlighting the need for continued infant testing. Full-Text PDF Open Access" @default.
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• W4288032947 date "2022-08-01" @default.
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• W4288032947 title "Dolutegravir in late pregnancy: where to from here?" @default.
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• W4288032947 doi "https://doi.org/10.1016/s2352-3018(22)00193-x" @default.
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