1. Dolutegravir in Pregnancy as Compared with Current HIV Regimens in the United States.
- Author
-
Patel, Kunjal, Yanling Huo, Jao, Jennifer, Powis, Kathleen M., Williams, Paige L., Kacanek, Deborah, Yee, Lynn M., Chadwick, Ellen G., Shiau, Stephanie, Jacobson, Denise L., Brummel, Sean S., Sultan-Beyer, Leila, Kahlert, Christian R., Zash, Rebecca, Seage III, George R., Huo, Yanling, Seage, George R 3rd, Pediatric HIV/AIDS Cohort Study and the Swiss Mother and Child HIV Cohort Study, Pediatric HIV/AIDS Cohort StudySwiss Mother and Child HIV Cohort Study, and Swiss Mother and Child HIV Cohort Study
- Subjects
- *
SMALL for gestational age , *DOLUTEGRAVIR , *LOW birth weight , *HIV-positive children , *HIV , *HIV infections , *ANTI-HIV agents , *PYRIDINE , *PREMATURE infants , *HETEROCYCLIC compounds , *HIV protease inhibitors , *RITONAVIR , *RESEARCH funding , *LONGITUDINAL method - Abstract
Background: Data on the effectiveness and safety of dolutegravir-based antiretroviral therapy (ART) for human immunodeficiency virus type 1 (HIV-1) infection in pregnancy as compared with other ART regimens commonly used in the United States and Europe, particularly when initiated before conception, are limited.Methods: We conducted a study involving pregnancies in persons with HIV-1 infection in the Pediatric HIV/AIDS Cohort Study whose initial ART in pregnancy included dolutegravir, atazanavir-ritonavir, darunavir-ritonavir, oral rilpivirine, raltegravir, or elvitegravir-cobicistat. Viral suppression at delivery and the risks of infants being born preterm, having low birth weight, and being small for gestational age were compared between each non-dolutegravir-based ART regimen and dolutegravir-based ART. Supplementary analyses that included participants in the Swiss Mother and Child HIV Cohort Study were conducted to improve the precision of our results.Results: Of the pregnancies in the study, 120 were in participants who received dolutegravir, 464 in those who received atazanavir-ritonavir, 185 in those who received darunavir-ritonavir, 243 in those who received rilpivirine, 86 in those who received raltegravir, and 159 in those who received elvitegravir-cobicistat. The median age at conception was 29 years; 51% of the pregnancies were in participants who started ART before conception. Viral suppression was present at delivery in 96.7% of the pregnancies in participants who received dolutegravir; corresponding percentages were 84.0% for atazanavir-ritonavir, 89.2% for raltegravir, and 89.8% for elvitegravir-cobicistat (adjusted risk differences vs. dolutegravir, -13.0 percentage points [95% confidence interval {CI}, -17.0 to -6.1], -17.0 percentage points [95% CI, -27.0 to -2.4], and -7.0 percentage points [95% CI, -13.3 to -0.0], respectively). The observed risks of preterm birth were 13.6 to 17.6%. Adjusted risks of infants being born preterm, having low birth weight, or being small for gestational age did not differ substantially between non-dolutegravir-based ART and dolutegravir. Results of supplementary analyses were similar.Conclusions: Atazanavir-ritonavir and raltegravir were associated with less frequent viral suppression at delivery than dolutegravir. No clear differences in adverse birth outcomes were observed with dolutegravir-based ART as compared with non-dolutegravir-based ART, although samples were small. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and others.). [ABSTRACT FROM AUTHOR]- Published
- 2022
- Full Text
- View/download PDF