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Global Health
May 19, 2020

Studies Explore HIV Treatment and Prevention in Pregnant Women

JAMA. 2020;323(19):1886. doi:10.1001/jama.2020.7627

Taking dolutegravir along with a single pill containing emtricitabine (FTC) and tenofovir alafenamide fumarate (TAF) is the safest, most effective option for pregnant women with HIV and their infants, according to a large international study presented recently at the Conference on Retroviruses and Opportunistic Infections (CROI).

In a clinical trial carried out in several African countries as well as in Brazil, India, Thailand, and the United States, 643 women with HIV were randomized to 1 of 3 antiretroviral regimens when they were 14 to 28 weeks’ pregnant.

The study found that 98% of women who received dolutegravir with either FTC and TAF or FTC and tenofovir disoproxil fumarate (TDF) combined were virally suppressed at delivery compared with 91% of women taking efavirenz and FTC and TDF. Two infants whose mothers took a dolutegravir-based regimen were diagnosed with HIV. Nearly one-quarter of the women taking dolutegravir and FTC and TAF had an adverse pregnancy outcome compared with 33% of women taking the other 2 drug regimens.

A second study presented at CROI found that pregnant teens and young women in sub-Saharan Africa had 30% lower blood concentrations of preexposure prophylaxis (PrEP) medication than nonpregnant women and men taking the drugs even though all 40 participants took PrEP under direct observation. Enhanced drug clearance by the kidneys and the normal hemodilution of pregnancy may explain some of the findings.

“While taking PrEP daily as directed is important for everyone who receives it, these new data suggest daily adherence to PrEP will be especially critical for pregnant adolescents and young women,” said Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, which funded the study.