supplementation with folic acid during pregnancy is one of the best ways to protect against this type of birth defect, but this is not routinely done in Botswana. Also, as mentioned, this birth defect had not been seen in pregnant women taking dolutegravir in other parts of the world. Alerts were issued to restrict its use, but we really had to wait for more deliveries.
The good news is that more and more babies were being born without the defect. At the International AIDS Society (IAS) conference held July 2019 in Mexico City, it was reported that the rates of this defect had fallen to 5 cases out of 1683 births, or 0.3%, as of spring 2019. This is the rate of defect when dolutegravir was taken during conception and appears more acceptable. If dolutegravir is started later in pregnancy, the rate is even lower.
This reduction in rate, in addition to the fact that this defect has not been seen in other populations make us think that the risk of harm to the fetus from the mother taking Dolutegravir is low. Women who want Dolutegravir during pregnancy now have the green light! This time, we didn’t have to wait over ten years.
Medical professionals and public health officials should always take precautions when we detect a potential problem related to medication safety. Sometimes, it’s a false alarm but we do the best with the information we have. First and foremost, “Do no harm”.
Dr. Crawford has over 25 years of experience in the treatment of HIV. While at Howard University School of Medicine, he worked in two HIV-specialty clinics at Howard University Hospital. He then did clinical research as a visiting scientist with the AIDS Clinical Trials Group (ACTG) at Johns Hopkins University School of Medicine. He served as the Assistant Chief of Public Health Research with the Military HIV Research Program where he managed research studies under the President’s Emergency Plan for AID Relief (PEPFAR) in four African countries.
He is currently working in the Division of AIDS in the National Institutes of Health. He has published research in the leading infectious diseases journals and serves on the Editorial Board of the journal AIDS. Any views and perspectives in his articles on blackdoctor.org are not representative of any agency or organization but a reflection of his personal views.