ART, contraception require further discussion in women with HIV
Click Here to Manage Email Alerts
Physicians should discuss risks associated with certain antiretroviral agents, such as dolutegravir, and contraception with women with HIV who are of childbearing age, researchers reported IDWeek.
“Women with HIV face the challenge of having to balance staying in care with multiple other responsibilities. An ART regimen consisting of the integrase inhibitor dolutegravir is often preferred by women because of the low pill burden, fewer adverse effects and overall simplicity of use,” Hira Hasan, a medical student at Louisiana State University Health Sciences Center, said during a virtual poster presentation.
In May 2018, however, the HHS issued a warning about a possible increase in neural tube defects among women who conceived while on dolutegravir. The warning, which was based on a preliminary analysis from an observational study in Botswana, recommended that a negative pregnancy test be confirmed before starting a woman on dolutegravir and also recommended that a regimen switch be made for a woman on dolutegravir who desired pregnancy, according to Hasan.
To learn more about how the warning may have affected ART regimens for women with HIV of childbearing age, Hasan and colleagues conducted a retrospective chart review of women aged 40 years and younger who were seen at the HIV Outpatient Program at University Medical Center in New Orleans.
Of the 132 women with a mean age of 33 years who were seen in 2018, the majority were African American and most had Medicaid or no insurance. The main risk factor for HIV was sexual transmission and the average age of diagnosis was 26 years.
Before May 2018, 46 of the 132 women, or 35%, were on a dolutegravir regimen. Of those 46 women, 12 received warnings about the risk for neural tube defects after the HHS warning. However, only three women changed their regimens as a result.
Contraception was also discussed with 80 of the 132 women, with 12 reporting use of a contraceptive and 21 reporting tubal ligations.
Overall, 47 pregnancies occurred among women on various ART regimens, including seven women on dolutegravir specifically. Forty-five pregnancies were completed, with no neural tube defects being reported.
“Dolutegravir is a great option for HIV due to its tolerability and simplicity of use. Unfortunately, warnings about dolutegravir possibly causing neural tube defects are alarming and have the potential to limit its use in women of childbearing years,” Hasan said. “While recent reports show risk of neural tube defects to be lower than previously thought, it is still elevated and an open discussion of neural tube defects, pregnancy plans and contraception need to occur in women living with HIV.”
Collapse
Hasan H, et al. Poster 1006. Presented at: IDWeek; Oct. 21-25, 2020 (virtual meeting).
Read more about
Click Here to Manage Email Alerts