DolPHIN-2: three quarters of HIV-positive women taking DTG from the third trimester gave birth to a healthy baby

The international conference on retroviruses and opportunistic infections (CROI2019) presented the positive results of a research project at the University of Liverpool aimed at reducing mother-to-child transmission of HIV.

The DolPHIN-2 Consortium, led by the University of Liverpool, was created to reduce the vertical transmission of HIV during pregnancy, childbirth and breastfeeding.

About 1.6 million women living with HIV become pregnant each year in the world. Without antiretroviral therapy, mother-to-child transmission of the virus ranges from 15 to 45 percent. With existing HIV treatment, this risk can be reduced to less than 5% if treatment is started in early pregnancy.

However, today still a significant number of pregnant women in tropical Africa go to maternity hospitals too late - in the last three months of pregnancy - and first-line ART does not have enough time to prevent transmission of the infection to newborns. Late initiation of treatment increases the risk of transmission of the virus by a factor of seven and doubles mortality during the first year of a child's life.

The ARV drug dolutegravir (DTG) has a higher rate of action than conventionally used therapy. DTG promptly reduces the level of HIV in the blood (achieving undetectable VL is possible within the first three months after the start of treatment) and, thus, potentially has significant advantages in preventing the transmission of the virus to newborns. However, the safety and efficacy of DTG in pregnant women is still the subject of study, and this lack of information is the main obstacle to its widespread use in pregnancy.

In this regard, the DolPHIN-2 program was aimed at conducting a large clinical study in Uganda and South Africa, where pregnant women were divided into groups to evaluate the effectiveness of therapy with the DTG-containing regimen in comparison with standard treatment.

Researchers found that 74% of women who received a third-trimester DTG regimen had an undetectable viral load at birth. However, only 43% of the participants from the standard therapy group based on efavirenza were able to achieve the same level.

“Mother-to-child transmission of HIV is preventable,” Professor Sai Hu explained, “and we must do everything to ensure that the burden of HIV is not transmitted from generation to generation.” Last year alone, over 100 thousand children were infected worldwide. ”

According to the expert, today we must make every effort so that new treatment methods are available to everyone. And the data obtained once again emphasize the significant difference in how efficiently modern ARV therapy works.

This is extremely important as many women in Africa find it too late that they are HIV-positive and it is extremely difficult to prevent the transmission of the virus to their unborn children.