- WHO has issued new recommendations on first- and second-line antiretroviral regimens for HIV.
- Dolutegravir (DTG) in combination with a nucleoside reverse-transcriptase inhibitor (NRTI) backbone is recommended as the preferred first-line regimen for people living with HIV and initiating antiretroviral therapy (ART).
Why this matters
- The 2019 updated guidelines provide the latest recommendations based on rapidly evolving evidence of safety and efficacy and programmatic experience using DTG and efavirenz (EFV) 400 mg in pregnant women and people coinfected with tuberculosis.
- 2 recent studies reported a lower risk increase than previously feared of neural tube defects with DTG exposure in utero.
- The guidelines group considered relative harms, benefits, and other factors in light of these new data in formulating their recommendation of DTG as first-line regimen.
- DTG in combination with a NRTI backbone is recommended as the preferred first-line regimen for people living with HIV initiating ART.
- This recommendation is rated as "strong" for adults and adolescents and "conditional" for infants and children with approved DTG dosing.
- EFV at a low dose (EFV400) combined with a NRTI backbone is recommended as an alternative first-line regimen for adults and adolescents living with HIV and initiating ART (strong recommendation).