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25/07/19

WHO recommends dolutegravir as the first-choice HIV treatment

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HIV breaks down and attacks the body's T cells so that it is unable to defend itself against different infections. WHO is “strongly recommending” dolutegravir (DTG) to treat patients. Copyright: Image byDarwin LaganzonfromPixabay(This image has been cropped.)

Speed read

  • WHO recommends dolutegravir (DTG) for all living with HIV, including pregnant women
  • Drug had previously been named as a possible cause of neural tube defects
  • New evidence shows risks are ‘significantly lower’ than thought: WHO

By:Cecilia Rosen

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[MEXICO CITY] A drug that had been feared to be causing serious birth defects is now the first-choice treatment forHIVafter the World Health Organization (WHO) said the risks were “significantly lower” than previously thought.

The WHO said it had changed its guidelines to “strongly recommend” dolutegravir (DTG) as the preferred first- and second-line treatment for all populations living with thedisease, including pregnant women and those of childbearing potential.

Last year, many countries advised pregnant women or those who might become pregnant to take efavirenz (EFV) instead, after a study in Botswana found a possible link between DTG and neural tube defects in newborn babies. These are defects of the brain, spine or spinal cord that develop in early pregnancy.

“To reverse the misperception about the level of risk will take another year. We lost two years in access to a drug that will save women's lives,”

Deborah Birx, US global AIDS coordinator

However, presentingnew researchfrom the ongoing Tsepamo study at the International AIDS Society (IAS)Conference on HIV Science, in Mexico, the WHO said the potential risk was “significantly lower” than previously estimated, with benefits for women probably outweighing the drawbacks.

DTG has proved to be safer, with fewer side effects and serves as ageneticbarrier todrugresistance to other antiretrovirals (ART) such as EFV, according to the WHO.

According to international organisation Unitaid, DTG-based regimes could enable low- and middle-income countries to expand ART therapy fast enough to reachUN targetsto end the HIV/AIDS epidemic by 2030, although challenges remain in terms ofprices for low-income countries.

Besides the new studies on the risk of neural tube defects, the newWHO guidelineswere based on mathematical models on the benefits and harms of DTG versus EFV, as well as the preferences of communities living with HIV, especially women, who globally represent half of the estimated 37.9 million affected by the disease.

Meg Doherty, from the WHO’s department of HIV, hepatitis and sexually transmitted infections, toldSciDev.Net: “Women don’t want to be told what they have to take; they want to be able to negotiate and discuss, having a conversation. And that doesn’t happen as often in very overcrowded, overburdened health centres or systems.”

Jaqueline Wambui, of the National Empowerment Network of People Living with HIV and AIDS in Kenya, said global and local health policies on HIV must take into account “what happens on the ground”.

Wambui believes the context in which these drugs are provided is key to understanding the prevalence of the disease.

For example, less than 40 per cent of women living with HIV have access to family planning services, according to the WHO, and folic acid supplementation, which helps prevent neural tube defects, is not always guaranteed.

For women to be able to make better-informed decisions, said Wambui, we must tackle the “communication gap” between expertise and communities.

“We have a lot of people stopping the treatment because they don’t understand they have to take it for a certain period of time, especially with HIV treatment, that it’s a lifetime treatment,” she said.

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Wambui, who has HIV, experienced this first-hand. Two years after being diagnosed, she developedtuberculosisbecause she stopped taking the treatment, she toldSciDev.Net, adding: “[It was] probably because I wasn’t prepared to take medication the rest of my life. If I had had the proper information about the risks of leaving the medication, I probably wouldn’t have had tuberculosis.

“We have seen a lot of science but we need to take into account what the people affected think of its developments.”

In 2019, 82 low- and middle-income countries have said they have transitioned to DTG-based treatment for HIV, the WHO has reported, although some fear that perceptions around the risks of the drug could take more time to change.

Deborah Birx, US global AIDS coordinator, told the IAS conference on Monday: “To reverse the misperception about the level of risk will take another year. We lost two years in access to a drug that will save women's lives.”

哈佛大学研究员兼DTG安全研究的首席作者丽贝卡·扎什（Rebecca Zash）在会议上告诉会议一种公共卫生方法，维持性别平等的艺术方法需要怀孕安全数据。她说，TSEPAMO研究的课程之一是，我们需要在艾滋病毒较高的国家中进行“可持续监视”，那里发生了90％以上的艺术妊娠暴露。