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The World Health Organization (WHO) has recommended the use of dolutegravir (DTG) as first-line and second-line treatment of choice for HIV in all populations, including pregnant women.
The recommendation is based on the new benefits and risks of HIV infection and evaluation, according to a WHO statement.
"DTG is a more effective medicine, easier to take and with fewer side effects than the alternative drugs currently in use. DTG also has a high genetic barrier to the development of drug resistance, which is important given the growing trend of resistance to nevirapine and EFV regimens, "the statement said.
Early studies revealed a possible link between DTG and conbad brain and spinal cord abnormalities that are causing conditions such as spina bifida in infants born to women using this drug at moment of conception.
According to the health organization, this potential safety problem would have been reported in May 2018 in a study conducted in Botswana, which revealed 4 cases of neural tube defects on 426 women who became pregnant while taking DTG.
On the basis of these preliminary results, many countries have advised pregnant women and women of childbearing age to take efavirenz (EFV).
But new data from two large clinical trials comparing the efficacy and safety of DTG and EFV in Africa have now broadened the evidence base.
"The risks of neural tube defects are significantly lower than those suggested by the initial studies," the statement said.
The guidelines group also examined mathematical models of the advantages and disadvantages of both drugs; the values and preferences of people living with HIV, as well as the factors related to the implementation of HIV programs in different countries, as well as their costs.
In 2019, 12 out of 18 countries surveyed by the WHO reported pre-treatment drug resistance levels above the recommended threshold of 10, which motivated the decision to update the 2019 guidelines.
"In 2019, 82 low- and middle-income countries reported transitioning to treatment regimens for HIV-based DTG.
The new updated recommendations are intended to help more countries improve their HIV policies, "he said.
As with any medication, it is important to make an informed choice.
"Each treatment decision should be based on an informed discussion with the health care provider badessing the benefits and potential risks," he said.
WHO has also emphasized the importance of providing information and options to help women make an informed choice.
— Daily guide
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