WHO okays DTG drug use on pregnant HIV+ mothers

BY DESMOND CHINGARANDE In Mexico City

The World Health Organisation (WHO) has given the Dolutegravir (DTG) drug a greenlight for use on pregnant women.

This follows research which reconfirmed that it was a preferred option for first line and second line antiretroviral treatment across all population with less side effects compared to previous studies that linked it to serious birth defects.

DTG is an antiretroviral medication used, together with other medication, to treat HIV and Aids and It may also be used, as part of post exposure prophylaxis, to prevent HIV infection following potential exposure.

Last year, WHO had to issue a note of caution about the use of DTG by women of child-bearing age as part of its interim guidelines, recommending it as preferred first and second line antiretroviral treatment after data from the Tsepamo study in Botswana suggested that the use of DTG in early pregnancy may be linked to neural tube defects (NTDs), serious birth defects of the brain and spine.

Researchers in Botswana also assessed the health of infants born to women in that study, saying they were concerned about the possibility that women who took DTG at the time they became pregnant had an increased risk of giving birth to an infant with a type of birth defect referred to as a neural tube defect.

After that study, several other countries in Sub-Saharan Africa then paused their plans to make DTG-based regimens their preferred first line therapy for people living with HIV.

But despite that study in Botswana, Pan African Positive Women Coalition director Tendai Westerhof, a member of the Zimbabwe Women Living with HIV/Aids Forum, issued a statement urging the Zimbabwe government to ignore the call and proceed with the administering of DTG on HIV positive pregnant women, saying it would help in the elimination of the mother-to-child transmission.

While addressing journalists at the 10th IAS Conference on HIV Science (IAS 2019) yesterday, WHO Treatment and Care in the Department of HIV/Hepatitis co-ordinator Meg Doherty issued updated recommendations to help clinicians and health ministries to act on the findings of retroviral therapy and DTG by giving them a green light for use.

“The additional research from Botswana has found that the risk of NTDs is less than what was signalled last year. To inform these recommendations, a number of community and scientific forums were held to discuss the issue directly with women of reproductive age who have the least access to obtaining DTG,” Doherty said.

“There is still a risk and countries need to monitor closely, but at this point Dolutegravir should be accessible for women of childbearing age due to the overwhelming benefits it offers. What treatment options to pursue is a decision that a woman should make in consultation with her healthcare provider.”

Deborah L Birx, United States Global Aids co-ordinator and US special representative for Global Health Diplomacy, also added that the President’s Emergency Plan for Aids Relief (PEPFAR) was also committed to supporting countries in their continued transition to DTG.

Zimbabwe is one of the countries in Southern Africa that have been receiving support from PEPFAR.

“DTG offers many benefits, including that it is better tolerated by the patient, leads to improved outcomes, such as faster viral suppression, and often costs less. It is clear that transitioning to DTG will accelerate our progress toward controlling the HIV epidemic,” Birx said.

The safety of the DTG HIV treatment drug during pregnancy has been one of the most urgent questions in global health for the past year.

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