Mother-to-Child HIV Transmission With In Utero Dolutegravir vs. Efavirenz in Botswana.
J Acquir Immune Defic Syndr
; 84(3): 235-241, 2020 07 01.
Article
en En
| MEDLINE
| ID: mdl-32195745
ABSTRACT
BACKGROUND:
A large-scale evaluation of mother-to-child transmission (MTCT) with dolutegravir (DTG)-based antiretroviral treatment (ART) has not been conducted previously.SETTING:
Botswana was the first African country to change from efavirenz (EFV)/tenofovir (TDF)/emtricitabine (FTC) to DTG/TDF/FTC first-line ART.METHODS:
From April 2015 to July 2018, the Early Infant Treatment Study offered HIV DNA testing at <96 hours of life. Maternal ART regimen was available for screened infants who could be linked to the separate Tsepamo surveillance study database. We evaluated characteristics of HIV-positive infants, and compared MTCT rates by ART regimen for linked infants.RESULTS:
Of 10,622 HIV-exposed infants screened, 42 (0.40%) were HIV-positive. In total, 5064 screened infants could be linked to the surveillance database, including 1235 (24.4%) exposed to DTG/TDF/FTC and 2411 (47.6%) exposed to EFV/TDF/FTC. MTCT was rare when either regimen was started before conception 0/213 [0.00%, 95% confidence interval (CI) 0.00% to 1.72%] on DTG, 1/1497 (0.07%, 95% CI 0.00% to 0.37%) on EFV. MTCT was similar for women starting each ART regimen in pregnancy 8/999 (0.80%, 95% CI 0.35% to 1.57%) for DTG and 8/883 (0.91%, 95% CI 0.39% to 1.78%) for EFV (risk difference 0.11%, 95% CI -0.79% to 1.06%). Most MTCT events (4/8 with DTG, 6/9 with EFV) occurred when ART was started <90 days before delivery. Infants exposed to DTG in utero had lower baseline HIV RNA compared with other HIV-infected infants.CONCLUSION:
In utero MTCT in Botswana remains rare in the DTG era. No significant MTCT differences were observed between DTG/TDF/FTC and EFV/TDF/FTC. Risk was highest for both groups when ART was started in the third trimester.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Contexto en salud:
2_ODS3
Problema de salud:
2_enfermedades_transmissibles
Asunto principal:
Infecciones por VIH
/
Transmisión Vertical de Enfermedad Infecciosa
/
Inhibidores de la Transcriptasa Inversa
/
Antirretrovirales
/
Compuestos Heterocíclicos con 3 Anillos
Tipo de estudio:
Etiology_studies
/
Risk_factors_studies
Límite:
Adult
/
Female
/
Humans
/
Pregnancy
País/Región como asunto:
Africa
Idioma:
En
Revista:
J Acquir Immune Defic Syndr
Asunto de la revista:
SINDROME DA IMUNODEFICIENCIA ADQUIRIDA (AIDS)
Año:
2020
Tipo del documento:
Article
País de afiliación:
Botswana