Archive for June 26, 2018

Comparative safety of dolutegravir-based or efavirenz-based antiretroviral treatment started during pregnancy in Botswana: an observational study.

Lancet Glob Health. July 2018 V.6 N.7 P.e804-e810.

Zash R1, Jacobson DL2, Diseko M3, Mayondi G3, Mmalane M3, Essex M4, Gaolethe T3, Petlo C5, Lockman S6, Holmes LB7, Makhema J3, Shapiro RL4.

Author information

1 Beth Israel Deaconess Medical Center, Division of Infectious Disease, Boston, MA, USA. Electronic address: rzash@bidmc.harvard.edu.

2 Center for Biostatistics in AIDS Research, Harvard TH Chan School of Public Health, Boston, MA, USA.

3 Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.

4 Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health, Boston, MA, USA.

5 Botswana Ministry of Health, Gaborone, Botswana.

6 Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, MA, USA.

7 Medical Genetics Unit, MassGeneral Hospital for Children, Boston, MA, USA.

Abstract

BACKGROUND:

Global rollout of dolutegravir-based antiretroviral therapy (ART) has been hampered in part by insufficient safety data in pregnancy. We compared birth outcomes among women initiating dolutegravir-based ART with those among women initiating efavirenz-based ART in pregnancy in Botswana.

METHODS:

In this observational study, we captured birth outcome data at eight government hospitals throughout Botswana (~45% of all deliveries in the country) in an ongoing study that started on Aug 15, 2014. In 2016, Botswana changed first-line ART from efavirenz-tenofovir-emtricitabine to dolutegravir-tenofovir-emtricitabine, including for pregnant women. This analysis includes women starting either efavirenz-based ART or dolutegravir-based ART during singleton pregnancy (regimen started and delivery occurring between Aug 15, 2014, and Aug 15, 2016, for efavirenz-based ART and between Nov 1, 2016, and Sept 30, 2017, for dolutegravir-based ART). We excluded births to mothers who had switched regimen or stopped ART. The primary outcomes were the combined endpoints of any adverse outcome (stillbirth, preterm birth [<37 weeks’ gestation], small for gestational age [SGA; less than the tenth percentile of birthweight by gestational age], or neonatal death [within 28 days of age]) and severe adverse outcomes (stillbirth, neonatal death, very preterm birth [<32 weeks’ gestation], and very SGA [less than the third percentile of birthweight by gestational age]). We fitted log-binomial regression models, controlling for maternal age, gravidity, and education, to estimate adjusted risk ratios (aRRs).

FINDINGS:

Our analysis included 1729 pregnant women who initiated dolutegravir-based ART and 4593 who initiated efavirenz-based ART. The risk for any adverse birth outcome among women on dolutegravir versus efavirenz was similar (33·2% vs 35·0%; aRR 0·95, 95% CI 0·88-1·03), as was the risk of any severe birth outcome (10·7% vs 11·3%; 0·94, 0·81-1·11). We found no significant differences by regimen in the individual outcomes of stillbirth, neonatal death, preterm birth, very preterm birth, SGA, or very SGA.

INTERPRETATION:

Adverse birth outcomes were similar among pregnant women who initiated dolutegravir-based and efavirenz-based ART. Dolutegravir-based ART can be safely initiated in pregnancy.

FUNDING: National Institutes of Health.

FULL TEXT

https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(18)30218-3/fulltext

PDF

https://www.thelancet.com/pdfs/journals/langlo/PIIS2214-109X(18)30218-3.pdf

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June 26, 2018 at 7:58 am


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