Women Suffering from Lack of Uptake of Preferred HIV Medication

Even after it was confirmed safe, women living with HIV are neglecting to use the drug dolutegravir, potentially subjecting them to worse HIV treatment outcomes.

In July 2019, the World Health Organization (WHO) indicated dolutegravir for all adolescents and adults living with HIV. This recommendation came after a safety signal in May 2018 that suggested exposure to dolutegravir at conception was associated with infant neural tube defects.

Although the WHO reviewed additional evidence and weighed the risks and benefits in before making their recommendation, dolutegravir uptake remains low among women living with HIV.

Investigators conducted an observational cohort study of 87 sites that began using dolutegravir in 11 low- and middle-income countries. Included sites participated in the International epidemiology Databases to Evaluate AIDS (IeDEA) from the Asia-Pacific, Caribbean, Central and South America network for HIV epidemiology (CCASAnet), and the Central, East, and Southern Africa regions.

The study, published in Annals of Internal Medicine, included 134672 patients 16-49 years of age who received care from January 2017-March 2020. The participants were either just beginning or had an existing antiretroviral therapy regimen.

By the end of the follow-up period, dolutegravir uptake among women 16-49 years old was 29.4%, compared to 57.7% of men in this age range. This gap in dolutegravir use was wider in countries that implemented the medication before the safety signal, and initially had restrictive policies, as opposed to countries that recommended dolutegravir after the WHO recommendation.

CUNY professor Denis Nash, the study’s senior author, discussed the implications of the results: “The large disparities quantified by our study mean that missed or delayed opportunities to improve HIV treatment outcomes could be substantial over the long run if they are not corrected quickly. We need more rapid and robust pharmacovigilance surveillance both before and after safety signals, which is important for reliably detecting, characterizing, and quantifying adverse events, and rigorously informing implementation decisions about the use of pharmaceuticals on a large scale.”

Dolutegravir has the potential to assist in eradicating HIV as a global public health threat. It has a superior efficacy profile, and reduces HIV transmission during sex, between needle-sharing partners, and in utero.

The study concluded, “Although this disparity was anticipated because of country-level restrictions on access, the results highlight its extent and initial persistence.”