WHO recommends dolutegravir (DTG) as preferred HIV treatment

Based on evidence from two large clinical trials, the World Health Organization (WHO) recommends dolutegravir (DTG) as the preferred first-line and second-line HIV treatment for all populations, including pregnant women, in lower- and middle-income countries.

The new recommendations are intended to ease uncertainty about the use of DTG in women of childbearing age. In 2018 the WHO issued a safety concern about the drug after the Botswana ‘Tsepamo’ study found a small link between DTG use at the time of conception and neural tube defects in infants.

In both trials, the risks of neural tube defects in infants conceived by women taking DTG were found to be significantly lower than initially suggested. The trials assessed the benefits and risks of DTG, and found that it is more effective, easier to take and has fewer side effects than alternative drugs currently used. The recommendations also stress the importance of transitioning to DTG in settings with rising resistance to non-nucleoside reverse transcriptase inhibitors (NNRTIs).