- WHO recommends dolutegravir (DTG) as first-, second-line HIV therapy for all populations, including pregnant women, women of reproductive age.
- Recommendations are based on new data comparing DTG and efavirenz (EFV) efficacy/safety in Africa that demonstrate significantly lower neural tube defects than initial evidence suggests.
Why this matters
- While DTG is recommended as first line, HIV treatment decisions should be based on an informed discussion with patients weighing benefits/risks, especially women of reproductive age or pregnant women.
- EFV 400 mg in combination with a nucleoside transcriptase inhibitor may be used as an alternative in adults, adolescents living with HIV who are initiating antiretroviral therapy.
- WHO statement was issued at the International AIDS Society (IAS) 2019 Annual Meeting.
- In addition to new trial data, guidance also considered mathematical modeling, value/preferences of people living with HIV, factors influencing HIV programs worldwide.
- DTG offers an alternative to increasing resistance to EFV, nevirapine-based regimens.
- 12/18 WHO-surveyed countries reported pretreatment drug resistance levels >10% in 2019.
- In 2019, 82 low-, middle-income countries reported transitioning to DTG-based regimens.
- Consult updated recommendations.