A new study from the University of Liverpool found a solution to most issues to reduce the likelihood of HIV transmission during pregnancy, childbirth and breastfeeding from a positive mother to a child in late pregnancy. The study was published in the journal «The Lancet HIV».
It is known that without ARV therapy, the risk of mother-to-child transmission of HIV is 15 to 45%. With ARV therapy, this risk can be reduced to less than 5% if treatment is started in the early stages of pregnancy.
A study from the University of Liverpool compared the reduction in viral load before childbirth in women taking Dolutegravir and Efavirenz. Women started taking ARV therapy in the third trimester. The study included pregnant women 18 years of age and older from South Africa and Uganda with confirmed HIV-positive status who had not previously received ARV therapy and were pregnant for 25 weeks. Participants were randomly divided into Dolutegravir and Efavirenz groups, and viral load was determined 7 and 28 days after the start of ART, at 36 weeks of gestation, and postpartum (0-14 days postpartum).
The primary efficacy endpoint was less than 50 copies per ml during the first postpartum visit, and the primary safety margin was determined by the incidence of side effects associated with maternal and infant use. Long-term monitoring of infants and their mothers continues.
In the period from January 23 to August 15, 2018, 268 mothers received ARV therapy, of which 135 - Dolutegravir and 133 - Efavirenz. The duration of ART use before delivery was 55 days. Viral load of less than 50 copies per ml was observed in 74% of women in the Dolutegravir group and 43% in the Efavirenz group.
Serious side effects were reported by 22% of women in the Dolutegravir group and 11% in the Efavirenz group. There were three stillbirths in the Dolutegravir group and 1 case in the Efavirenz group, but all cases were considered unrelated to ARV treatment. Three children were born with HIV - all in the Dolutegravir group; these cases are attributed to intrauterine infection.
Conclusion: The results support the revised WHO guidelines for switching to Dolutegravir in the first-line regimens for all adult men and women living with HIV, regardless of whether they are pregnant or not.