Comparative Analysis of Effectiveness of Dolutegravir-Based Regimen (TLD) vs. Efavirenz-Based Regimen (TLE) to Prevent Mother-to-Child Transmission of HIV

TL;DR

This study compares two HIV treatment regimens for pregnant women to see which is better at preventing HIV transmission to their babies.

Contribution

The study provides evidence on the effectiveness of dolutegravir-based regimen in preventing mother-to-child HIV transmission in India.

Findings

No infants in the dolutegravir-based regimen group tested HIV-positive.

The efavirenz-based regimen group had a 4.6% mother-to-child transmission rate.

Dolutegravir-based regimen showed a trend toward lower transmission but not statistically significant.

Abstract

Background: The National AIDS Control Organisation (NACO) in India now recommends a dolutegravir-based regimen (TLD) for pregnant women to prevent mother-to-child transmission (MTCT) of HIV. However, evidence comparing its effectiveness with the previously used Efavirenz-based regimen (TLE) in reducing MTCT remains limited.

Aim: To compare the effectiveness of the TLD and TLE regimens in preventing mother-to-child transmission of HIV.

Methodology: HIV-positive pregnant women initiated on the TLD regimen were categorized as group A, while those receiving the TLE regimen formed group B. All newborns received nevirapine prophylaxis and underwent HIV testing at 6 weeks, 6 months, 12 months, and 18 months of age.

Result: Among the 67 women in group A, no infants tested positive for HIV. In group B, two infants were HIV-positive (MTCT rate 4.6%). The difference in transmission rates showed no statistical significance (χ²= 2.816; p=0.09), but the DTG-based (TLD) regimen showed a trend toward lower MTCT compared to the EFV-based (TLE) regimen. At initiation, the mean CD4 count in the TLD group was 444.5±199.79 cells/mm with a slight decline after 6 months of therapy (CD4 count= 405.09±147.52). The mean birth weight was 2.75±0.39 kg in group A and 2.59±0.46 in group B.

Conclusion: The TLD regimen was associated with a trend towards lower MTCT of HIV compared to the TLE regimen. Thus, continued use of dolutegravir-based therapy is recommended to support national and global goals of eliminating new HIV infections among exposed infants.