The British HIV Association (BHIVA) has issued a statement on conception in women who are using dolutegravir (DTG), following new data on the risk of neural tube defects (NTDs) from a study in Botswana. Key points from the 10-point statement include:
- Women taking DTG who wish to conceive should be informed that the prevalence of NTDs is higher following DTG exposure at conception than with other types of ART (3 per 1000 births vs 1 per 1000 births).
- Women choosing to continue DTG while planning to conceive should be supported in this decision and advised to start or continue folic acid 5 mg daily until closure of the neural tube.
- Women using DTG who become pregnant should be informed of the 0.3% risk of NTD. Detailed anomaly scans should be performed in line with national pregnancy guidelines; no additional scans are required.
The authors note that the neural tube has closed within six weeks of conception. All women wishing to conceive should be given appropriate preconception advice and commenced on a high dose of folic acid (5 mg daily), regardless of their cART regimen, the statement says. Women living with HIV should be given all available information and supported to make informed choices regarding ART at all stages of their reproductive life.
The BHIVA also encouraged clinicians to prospectively report pregnancies to the National Surveillance of HIV in Pregnancy and Childhood (www.ucl.ac.uk/nshpc) and the Antiretroviral Pregnancy Registry.
