Page 5 - Nursing Matters June 2021 Vol 12

as well as patient autonomy. Also take It would be remiss to talk about HCWs to practice with a conscious focus
note of the SAHCS statement on the use achieving treatment targets or virological on virological suppression; including
of DTG during pregnancy and in women suppression without considering the small techniques, strategies and resources that
of childbearing potential (below). This but growing population of treatment- amplify the invaluable contribution made
statement has prompted our National experienced HIV-positive patients being by nurses in managing the HIV epidemic
Department of Health to consider initiated on third-line treatment regimens, on the frontline.
this latest evidence and undertake a otherwise known as third-line ART
guideline review process. (TLART). Lancaster (page 18) provides Finally, a special word of thanks goes to
an easily digestible presentation of the Anglo American Chairman’s Fund
Manqoba et al. (pg. 15) remind us of TLART implementation. She emphasizes (AACF) who have kindly contributed
the importance of early CrAg screening the critical role played by nurses as towards SAHCS’ publishing costs of HIV
for patients with advanced HIV disease anchors of the multi-disciplinary team Nursing Matters over the past several
(ADH). The recent change in the CrAg when managing a TLART programme in years. We couldn’t have continued
screening guidelines highlights the a primary healthcare setting. without this support, and we are
importance of not losing sight of a saddened that this edition represents the
patient’s quality of life and the human This edition is filled with technical and final grant the AACF is able to make.
rights aspects of treatment effectiveness. informational resources to support

STATEMENT ON DOLUTEGRAVIR (DTG) USE IN

PREGNANCY & FOR WOMEN OF CHILDBEARING

POTENTIAL (WOCP) - 19 May 2021

Problem Statement
As more data has been added to the Tsepamo cohort, the difference in DTG vs non-DTG regimens regarding neural tube
defect (NTD) risk is now no longer statistically significant. In addition, other cohorts, albeit smaller ones, have not found any
1
increase in NTDs when dolutegravir was being taken at conception. Therefore, there is no longer any clear signal of harm.
2,3
In contrast, there are benefits to DTG over EFV with respect to virological suppression rates, virological barrier to resistance,
tolerability, and side-effects, and many of these may well also translate to better overall maternal and fetal outcomes. 4-6

Recommendations
The Southern African HIV Clinicians Society (SAHCS), therefore, recommends DTG-containing regimens as the preferred
first-line antiretroviral therapy due to superior efficacy, tolerability and higher threshold for resistance when compared to EFV-
containing regimens. All ART-naive individuals testing HIV serum positive must be initiated onto a DTG-containing regimen and
SAHCS recommends TLD as first line treatment for all, whether the individual is male or female; pregnant or of childbearing
potential or not.

In addition, virologically suppressed women of childbearing potential on non-DTG first- and second-line regimens can be
safely switched to DTG-based regimens if appropriate. Always confirm viral suppression prior to switching regimens.

As any medication use during conception and pregnancy carries some risk, counselling is still advised.

References
1. Clayden, P. (2020) Hi-B. Neural tube defects in two of Inhibitors During Pregnancy? J Acquir Immune Defic Syndr. Colbers, A., Byrne, K., et al. (2020). Dolutegravir versus
1000 conception exposures with dolutegravir: reassuring 2019;81(4):481-6. efavirenz in women starting HIV therapy in late pregnancy
update from Tsepamo study 2020 [Available from: https:// (DolPHIN-2): an open-label, randomised controlled trial.
i-base.info/htb/38422]. 4. Phillips, A.N., Bansi-Matharu, L., Venter, F., Havlir, D., Lancet HIV. 2020;7(5):e332-e9.
Pozniak, A., Kuritzkes, D.R., et al. (2020). Updated
2. Sibiude, J.L.J., Mandelbrot, L., et al. (2019). No Increase assessment of risks and benefits of dolutegravir versus 6. aidsmap.com. (2020). Dolutegravir-based HIV treatment is
in Birth Defects in Infants Exposed to Integrase Inhibitors at efavirenz in new antiretroviral treatment initiators in sub- the safest and most effective choice for pregnant women
Conception. CROI 2019. Saharan Africa: modelling to inform treatment guidelines. 2020 [Available from: https://www.aidsmap.com/news/
3. Chouchana, L., Beeker, N., Treluyer, J.M. (2019). Is Lancet HIV. 2020;7(3):e193-e200. mar-2020/dolutegravir-based-hiv-treatment-safest-and-
most-effective-choice-pregnant-women
There a Safety Signal for Dolutegravir and Integrase 5. Kintu, K., Malaba, T.R., Nakibuka, J., Papamichael, C.,
HIV Nursing Matters | June 2021 | page 3