28 June 2018

Recently (May 2018) a study in Botswana reported an increased incidence (0.9%) of neural tube defects (NTDs) amongst infants born to women who received dolutegravir (DTG) at conception or early in the first trimester, compared to 0.1% NTDs observed with other antiretrovirals.

Based on these findings the EMA, FDA and WHO issued a safety alert on the use of dolutegravir during conception, and advise not to prescribe dolutegravir for women of child bearing potential who are trying to become pregnant. This underlines the importance of prospective studies in pregnancy.
In Clinical Pharmacokinetics David Burger, Angela Colbers, Rob ter Heine en Ruben van der Galiën discuss that although yearly over a million of women with HIV get pregnant, it is often still unknown whether treatment with HIV-integrase inhibitors results in adequate drug exposure. The major mechanisms between altered exposure, the clinical implication and the remaining knowledge gaps are discussed.

Pharmacokinetics of HIV-Integrase Inhibitors During Pregnancy: Mechanisms, Clinical Implications and Knowledge Gaps.
van der Galiën R, Ter Heine R, Greupink R, Schalkwijk SJ, van Herwaarden AE, Colbers A, Burger DM.

David Burger, Angela Colbers and Rob ter Heine are members of theme Infectious diseases and global health.

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