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Dolutegravir Offers Superior HIV Suppression in Pregnant Women

Pregnant people taking dolutegravir were more likely to achieve HIV viral suppression and less likely to have a preterm birth than participants using other forms of ART.

Undetectable equals untransmissible (U=U), meaning that people with HIV who achieve an undetectable viral load via antiretroviral therapy (ART) will not be at risk of passing on the infection. Maintaining an undetectable viral load is especially vital for pregnant people, to ensure there will be no vertical transmission of HIV to their babies.

One study, published recently in the New England Journal of Medicine, sought to compare the efficacy and safety of different ART regimens in pregnant women. The study recruited persons who were pregnant and living with HIV-1 infection; participants were identified using the Pediatric HIV/AIDS Cohort Study.

The participants’ initial ART in pregnancy included dolutegravir, atazanavir–ritonavir, darunavir–ritonavir, oral rilpivirine, raltegravir, or elvitegravir–cobicistat. Between each ART regimen, the investigators compared viral suppression at delivery, as well as risk of preterm birth, low birth weight, and small for gestational age.

Of the pregnant people examined in this study, 120 received dolutegravir, 464 received atazanavir–ritonavir, 185 received darunavir–ritonavir, 243 received rilpivirine, 86 received raltegravir, and 159 received elvitegravir–cobicistat. The average age at conception was 29 years, and 51% of participants had initiated ART before becoming pregnant.

“Our study showed that dolutegravir-based regimens had a high probability of maternal viral suppression at delivery, and there were no observable differences in the risks of adverse birth outcomes, such as preterm birth, low birth weight, small for gestational age, or neonatal death, between dolutegravir and the other contemporary regimens,” said Ellen Chadwick, MD, a professor of pediatrics at the Northwestern University Feinberg School of Medicine. “This is great news, since dolutegravir also has other important benefits compared to older antiretroviral drugs.”

HIV viral suppression at delivery was observed in 96.7% of the dolutegravir cohort, 84.0% for atazanavir–ritonavir recipients, 89.2% for raltegravir recipients, and 89.9% for elvitegravir–cobicistat recipients. Before adjusting the results, the risk of preterm birth was found to be 13.6% in the dolutegravir group and 17.6% for participants using other forms of ART.

Specifically, the pregnant patients using atazanavir–ritonavir or raltegravir for ART were less likely to achieve viral suppression than the dolutegravir participants. There were no significant differences in adverse birth outcomes between the dolutegravir and non-dolutegravir groups, although the investigators recommended this study be repeated with larger cohorts.

“This is one of the largest studies to examine the effectiveness and safety of dolutegravir in pregnancy, said Jennifer Jao, MD, MPH, an infectious diseases physician at Lurie Children’s and associate professor of pediatrics at Northwestern University Feinberg School of Medicine. “Our results show viral suppression at delivery in considerably more participants.”