The National Essential Medicines List Committee has reviewed the evidence for dolutegravir (DTG) compared with efavirenz (EFV) in pregnancy, and has determined that the benefits outweigh the risks. DTG is therefore recommended as part of the preferred first line ART regimen for all adults and adolescents living with HIV, including pregnant women and women of child-bearing potential.
Evidence of benefit:
- Two randomised controlled trials conducted in pregnant women found that DTG caused more rapid virological suppression than EFV, resulting in more women being virologically suppressed at delivery.
- In a surveillance study in Botswana, rates of vertical transmission were low, and were similar for DTG and EFV (8/999 and 8/883 respectively, risk difference 0.11%, 95% CI -0.79 to 1.06%).
- DTG has a higher virological barrier to resistance than EFV.