In a recent report presented at the Conference on Retroviruses and Opportunistic Infections (CROI 2024) in Denver, Professor Risa Hoffman revealed findings from the IMPAACT 2010 study, indicating that dolutegravir, a commonly used HIV medication, did not elevate the risk of high blood pressure during pregnancy. Although mildly raised blood pressure was observed among young women with HIV, there was no significant correlation with dolutegravir usage.
The IMPAACT 2010 study, a comprehensive investigation into the effectiveness and safety of various antiretroviral regimens administered during pregnancy, compared dolutegravir- and efavirenz-containing treatments. Additionally, it examined different formulations of tenofovir when combined with dolutegravir and emtricitabine. Notably, women who initiated dolutegravir-based treatment during the second trimester of pregnancy exhibited higher rates of suppressed viral load at delivery compared to those on efavirenz, which substantially decreases the risk of vertical HIV transmission.
Furthermore, the study highlighted that women receiving dolutegravir experienced fewer adverse pregnancy outcomes, such as stillbirth and low birth weight for gestational age, with increased weight gain during pregnancy associated with reduced risks.
A post-hoc analysis presented by Professor Hoffman involved monitoring blood pressure changes among trial participants. The study enrolled 643 women across 11 countries, equally distributing them among the three study regimens between 14 and 28 weeks of gestation. Blood pressure measurements were taken throughout pregnancy, at delivery, and during a 50-week postpartum follow-up period. Results revealed that modest increases in blood pressure were common, with gestational hypertension diagnosed in a small percentage of participants.
Despite slight variations in blood pressure among the different treatment arms, there was no discernible association between antiretroviral regimen and the risk of developing hypertension during pregnancy. Notably, weight emerged as a critical factor, with increased weight correlating with a heightened risk of hypertension.
Dr. Hoffman emphasized the importance of maintaining a healthy body weight, particularly before conception, to optimize outcomes across pregnancies and ensure long-term health for women on dolutegravir-based ART.
Additional studies presented corroborated these findings. In Botswana, the Tsepamo study comparing pregnancy outcomes in women with and without HIV found no substantial difference in the incidence of high blood pressure during pregnancy between those taking dolutegravir and efavirenz. Similarly, the DOLPHIN-2 trial, conducted in South Africa and Uganda, found no significant variance in postpartum blood pressure based on the antiretroviral regimen initiated late in pregnancy.
These collective findings provide reassurance regarding the safety of dolutegravir during pregnancy, underscoring the importance of ongoing research to optimize maternal and infant health outcomes in women living with HIV.
