Dolutegravir versus efavirenz in women starting HIV therapy in late pregnancy (DolPHIN-2)

12 May 2020

In Lancet HIV RIHS researchers Angela Colbers and David Burger showed in an open-label, randomized controlled trial, that, when initiated in the 3rd trimester of pregnancy, achievement of VL <50cp/mL at delivery was more likely with dolutegravir-based therapy than with efavirenz-based regimens.

The trial was executed in Uganda and South Africa and we included 268 women living with HIV, diagnosed in late pregnancy. Our study addresses an important knowledge gap around antepartum transmission of HIV in women initiating treatment late in pregnancy. Dolutegravir was associated with higher rates of viral load reduction compared with efavirenz in pregnant women. Although both regimens were well tolerated by mothers and infants, more mothers who received dolutegravir developed serious adverse events (driven mainly by prolonged pregnancies) than did those who received efavirenz.
Our data support the revision to WHO guidelines recommending the transition to dolutegravir in first-line ART for all adults, regardless of pregnancy or child-bearing potential. The importance of the finding of more adverse events in mothers in the dolutegravir group is unclear and should be confirmed in other studies.

Learn more about DolPHIN-2

publication in Lancet HIV

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