The results of DolPHIN-1 are summarized: dolutegravir is better than efavirenz cures HIV in women at the extreme stages of pregnancy
Dolutegravir demonstrated greater efficacy in suppressing HIV than efavirenz in late pregnancy, Dr. Saye Hu said at the 22nd International AIDS Conference (AIDS2018). According to him, the results of the DolPHIN-1 study showed that in pregnant women of HIV-positive women in several countries in Africa, the suppression of viral load occurred almost twice as fast when starting the reception of antiretroviral therapy regimens based on dolutegravir in comparison with EFV-based antiretroviral therapy.
The scientist said that every year in the world there are at least 1.5 million HIV-positive women waiting for a child. At the same time, at least 90% of them live in low-income countries and do not have access to diagnosis and treatment of HIV. So, according to Dr. Saye Hu, up to 20% of pregnant HIV-positive women in South Africa are very late taking ARV medications.
In such a situation, the probability that a child will be born with HIV increases sevenfold. Also, the risk of premature death of a baby in the first year is doubled.
According to experts, if a pregnant woman is diagnosed with a virus at week 35, then her mother will only have two or three weeks to suppress her. In this case, she simply does not manage to reach the undetectable level of viral load (<50 copies / ml) by the time of delivery.
In view of this, it is simply necessary to create treatment regimens that, with a mild side-effect profile and no risk to the mother and fetus, will reduce the number of copies of the virus in the body as quickly as possible.
A team of scientists found that several dozens of HIV + pregnant women from Kampala (Uganda) and Cape Town (South Africa) in late terms suppressed HF occurred faster when starting treatment regimens including dolutegravir, compared with EFV-based antiretroviral therapy.
In the DolPHIN-1 study, specialists compared two regimens of the first line: two nucleoside reverse transcriptase inhibitors (tenofovir / lamivudine in Uganda, tenofovir / emtricitabine in South Africa) + the third component: efavirenz (600 mg) or dolutegravir (50 mg).
The scientists found that the time required to achieve undetectable VL for dolutegravir-based therapy was on average half that of the regimen with efavirenz.
So, two weeks after the birth, undetectable BH (<50 copies / ml) in women from the dolutegravir group was observed more often - in 74.1%, while in the efavirenz group this indicator was found only in 40% of cases.