Uso de dolutegravir em gestantes vivendo com HIV no Brasil, entre 2020 e 2022

Abstract

Lino Neves da Silveira, Use of dolutegravir in pregnant women living with HIV in Brazil, between 2020 and 2022. Dissertation to obtain a master's degree in infectious diseases – Federal University of Espírito Santo, Vitória, 2023. Introduction: HIV mother-to-child transmission (HIV-MTCT) is a significant contributor to the HIV pandemic. Among the determinants of HIV-MTCT control are the use of antiretroviral therapy (ART) during pregnancy and suppression of maternal HIV viral load (HIV-VL). For these reasons, it is essential to collect information that determines the effectiveness of ART regimens during pregnancy. Objective: To evaluate the effectiveness of DTG in pregnant women in Brazil. Methods: Retrospective cohort study, including pregnant women starting ART, stratified according to the antiretrovirals (ARV) of interest, using data from national HIV monitoring systems, in the years 2020 and 2022. The outcome variable is CV-HIV<50 copies/mm3, in laboratory exam closer to the delivery date. Results: 3,208 pregnant women were analyzed. The distribution of pregnant women by ARV was as follows: efavirenz (334), dolutegravir (2,014), raltegravir (699), atazanavir/ritonavir (161); pregnant women using darunavir/ritonavir were excluded from the analysis due to the reduced sample. It was observed that 74.1% of pregnant women who received DTG achieved viral suppression, while the same outcome was observed in 67.5% of the EFV group, 72.2% of the RAL group, and 70.8% of the ATV/r group. These values represent a total percentage of 72.8% of pregnant women with undetectable CV-HIV at the time of delivery. The multivariate analysis model demonstrated that pregnant women who start ART containing DTG have an odds ratio of 1.33 (95% CI 1.03-1.72) of achieving viral suppression at the time of delivery, when compared to pregnant women who started EFV. Conclusion: The use of dolutegravir during pregnancy is associated with a greater likelihood of achieving viral suppression at birth compared to those who used efavirenz. This finding reinforces the national recommendation to prioritize the class of integrase inhibitors in the preferred regimen for pregnant women living with HIV.