Treating Pregnant Women With HIV

Segment Description: Saye Khoo, MD, professor at the University of Liverpool, advocates for a more appropriate, stratified, risk-based approach to prescribing dolutegravir in pregnant women.

Contagion®: Based on the results of your work, what is your message to clinicians who are treating pregnant women with HIV?

Dr. Khoo: One of the emerging themes that has come out in the past year and been very strongly articulated at CROI this year is the need to get efficacy and safety data in pregnant women and to have it in a timely manner. It has been a long-standing problem that women are viewed as a vulnerable group and end up being a neglected population in terms of getting the requisite evidence to treated safely and effectively.

What we have shown is that in a certain group of women at high-risk of transmission is that dolutegravir could potentially decrease the viral load much faster than the current standard-of-care. Over the last year, dolutegravir has mixed press, it’s certainly a very effective drug that has been rolled out across the globe, but there have been some alerts about the potential for birth defects or neural tube defects, which are yet unconfirmed at preliminary.

However, the response to this concern has very understandably been heightened by the report as so different countries have implemented different things. There are countries that say ‘we can use dolutegravir freely in pregnancy outside of the first trimester,’ which is when the risk of neural tube defects is, ranging to countries that have said ‘no dolutegravir to any women of child bearing age whatsoever.’

So, I think we’re arguing for a much more appropriate, stratified, risk-based approach to taking dolutegravir. And in the third trimester, when the organs have already formed, there is very little risk of congenital malformation and a lot of benefit potentially from the rapid viral load reduction.