Dolutegravir-Based First-Line Antiretroviral Therapy Seems Safe During Pregnancy

Dolutegravir, an integrase strand transfer inhibitor with superior efficacy and tolerability and a higher resistance barrier than other antiretrovirals, was introduced in Botswana in 2016 as a first-line antiretroviral therapy (ART) for all adults with HIV (including pregnant women, despite limited data). In this observational multicenter study in Botswana, researchers assessed birth outcomes among 1729 women starting a dolutegravir-based regimen compared with 4593 women initiating efavirenz-based ART during pregnancy.

Rates of adverse birth outcomes were similar among women initiating dolutegravir-based ART compared with those using an efavirenz-based regimen (33.2% and 35.0%, respectively). Risk for severe adverse birth outcomes was also similar (10.7% and 11.3%). Compared with HIV-negative women, those with HIV had higher risk for any adverse birth outcome (28.9% vs. 34.5%) regardless of ART regimen.