The World Health Organisation (WHO) has recommended the use of Dolutegravir (DTG) as the preferred first-line and second-line treatment for HIV in all populations, including pregnant women.
The recommendation is based on new assessment benefits and risks of the HIV disease, a release issued by the WHO said.
“The DTG is a drug that is more effective, easier to take and has fewer side effects than alternative drugs that are currently used. DTG also has a high genetic barrier to developing drug resistance, which is important given the rising trend of resistance to EFV and nevirapine-based regimens,” the statement said.
It said initial studies had highlighted a possible link between DTG and birth defects of the brain and spinal cord that cause conditions such as spina bifida in infants born to women using the drug at the time of conception.
This potential safety concern the health organization said was reported in May 2018 from a study in Botswana that found 4 cases of neural tube defects out of 426 women who became pregnant while taking DTG.
It said based on these preliminary findings, many countries advised pregnant women and women of childbearing potential to take efavirenz (EFV) instead.
But new data from two large clinical trials comparing the efficacy and safety of DTG and EFV in Africa have now expanded the evidence base.
“The risks of neural tube defects are significantly lower than what the initial studies may have suggested,” the statement said.
The guidelines group also considered mathematical models of the benefits and harms associated with the two drugs; the values and preferences of people living with HIV, as well as factors related to implementation of HIV programmes in different countries, and cost.
Twelve out of 18 countries surveyed by WHO in 2019, reported pre-treatment drug resistance levels exceeding the recommended threshold of 10, Which informed the decision to update the 2019 guidelines.
“In 2019, 82 low- and middle-income countries reported to be transitioning to DTG-based HIV treatment regimens.
The new updated recommendations aim to help more countries improve their HIV policies,” it said.
It said as for any medications, informed choice is important.
“Every treatment decision needs to be based on an informed discussion with the health provider weighing the benefits and potential risks,” it said.
The WHO also stressed the importance of providing information and options to help women make an informed choice.
By Jamila Akweley Okertchiri