WHO reverses course on dolutegravir, recommends first line for all populations

  • WHO newsroom
  • WHO
  • 23 Jul 2019

  • International Clinical Digest
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Takeaway

  • 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.

Key points

  • 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.