Metabolic implications and safety of dolutegravir use in pregnancy.

Valeriya Dontsova, Haneesha Mohan, Camille Blanco, Jennifer Jao, Nicholas D E Greene, Andrew J Copp, Rebecca Zash, Lena Serghides

Journal: The lancet. HIV 2023;10(9):e606-e616

PMID: 37549681

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Abstract

Dolutegravir is recommended for all people living with HIV because of its efficacy, high barrier to resistance, favourable safety and tolerability profile, and affordability. Dolutegravir has the highest rates of viral suppression in pregnancy, therefore preventing perinatal HIV transmission. In view of these benefits, particularly for pregnant women, an important question is if dolutegravir is safe in pregnancy. Dolutegravir has been associated with metabolic complications, including weight gain and rare events of hyperglycaemia, that could affect maternal, fetal, and postnatal health. We review the current clinically and experimentally based literature on the implications of dolutegravir use for pregnant women and for developing embryos and fetuses. Possible effects on folate status, energy metabolism, adipogenesis, and oxidative stress are considered. In many instances, insufficient data are available, pointing to the need for additional research in this important area of HIV treatment.

Address: Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.; Department of Pediatrics, Division of Pediatric Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.; Developmental Biology and Cancer Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK.; Department of Medicine, Division of Infectious Disease, Beth Israel Deaconess Medical Center, Boston, USA.; Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada; Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada; Department of Immunology and Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada. Electronic address: [email protected].

DOI: 10.1016/S2352-3018(23)00141-8

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MeSH Terms: Pregnancy, Humans, Female, HIV Infections, Oxazines, Heterocyclic Compounds, 3-Ring, Piperazines