The United States Department of Health and Human Services (DHHS) recently updated its guidelines on the use of antiretroviral agents in pregnant women with HIV infection. Dolutegravir is newly listed as a preferred agent to initiate during the second and third trimester of pregnancy. However, the guidelines reiterate a conservative interim recommendation that dolutegravir not be initiated during the first trimester of pregnancy based on preliminary data from a study in Botswana raising concerns about a possible small increased risk of neural tube defects with maternal dolutegravir use around the time of conception. The recommendation will likely be clarified as further data become available. Our recommendations are generally consistent with these guidelines.
- Department of Health and Human Services (HHS) Panel on Treatment of HIV-Infected Pregnant Women and Prevention of Perinatal Transmission. Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States. http://aidsinfo.nih.gov/guidelines/html/3/perinatal-guidelines/0/ (Accessed on December 07, 2018).