Dolutegravir (DTG) in Pregnancy and Safe Conception in Women

Benefits of Dolutegavir

Switching existing clients to DTG-Containing Regimens

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BENEFITS OF DOLUTEGRAVIR¹⁶

• Superior Efficacy
• Side-effects are mild and uncommon
• High genetic barrier to resistance
• Cost effective
• Small tablet
• No interaction with hormonal contraceptives
• Can be used with TB treatment if boosted

Evolving evidence has found there to be no significant difference in neural tube defect (NTD) prevalence between DTGand EFV-exposure at conception¹⁷.

TLD is now the preferred first-line regimen in all WOCP, regardless of her intentions to conceive, her pregnancy status, or whether she is using contraception or not.

Concerns regarding neural tube defects (NTDs) on DTG in previous years created an important focus on the integration of contraception into ART services.

Contraception services should continue to be offered with ART and child health services in an integrated and patient-centred manner. This is especially urgent if the women’s VL is not suppressed.

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All Adult and Adolescent Females and Males ≥ 30 kg and ≥ 10 years of Age
TDF + 3TC + DTG (TLD)

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SWITCHING EXISTING CLIENTS TO DTG-CONTAINING REGIMENS

Women who have already initiated ART on non-DTG containing regimens should be transitioned to a DTG-containing regimen as a matter of urgency. The table below provides guidance on non-VL dependent switching of existing clients to DTG-containing regimens.

NON VL-DEPENDENT REGIMEN SWITCHES Regimens where the VL result will not influence nor delay the decision to switch to a DTG-containing regimen			VL-dependent switches to DTG Women who have been on PI-based regimens for more than two years also require a transition to a DTG-containing regimen. However, transitions in these women are VL dependent: their VL result in the last 12 months will influence the decision of how and when to switch to a DTG-containing regimen. For further guidance, please refer to “Switching Existing Clients to DTG-containing Regimens”of the 2023 ART Clinical Guidelines
Current Regimen	Criteria for switch	Regimen if change indicated
TEE	Switch all to a DTG-containing regimen, regardless of VL result Do VL at booking/1st ANC visit as for all pregnant women on ART. If VL at booking visit is not suppressed, continue to switch same day, but do ABCDE assessment and provide enhanced adherence counselling (EAC) if needed.	TLD provided no renal dysfunction and age > 10 yrs and weight > 30 kg If client does not qualify for TDF ABC/3TC/DTG If client does not qualify for TDF and has ABC hypersensitivity AZT/3TC/DTG
ABC/3TC/EFV
AZT/3TC/EFV
AZT/3TC/DTG
On any LPV/r or ATV/r regimen for less than 2 years duration

Click here for the pdf.

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South African National Department of Health, Guideline for Vertical Transmission Prevention of Communicable Infections, Version 2_August 2023