Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden.
Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden.
Eur J Clin Microbiol Infect Dis. 2018 Mar;37(3):495-500. doi: 10.1007/s10096-018-3195-9. Epub 2018 Feb 2.
The development of new drugs for treatment of HIV has increased the efficacy and the quality of life together with decreased unwanted side-effect for people living with HIV. The integrase inhibitor dolutegravir has in short time become part of the first-line treatment in many countries, but is not a recommended first-line drug in pregnancy. As there are few publications of dolutegravir use during pregnancy, we found it valuable to analyze the Stockholm pregnancy cohort. A retrospective analysis of all pregnant women and their infants exposed to dolutegravir at Karolinska University Hospital, 2014-August 2017. Information about maternal health, treatment, pregnancy, and child outcome were collected. Thirty-six women with singleton pregnancies were included. Four early spontaneous abortions occurred. One late termination was performed and one was lost to follow-up. Fourteen were on dolutegravir before and 22 started during pregnancy. Eighteen delivered by caesarean section, three of them because of HIV RNA > 50 copies/mL. The preeclampsia rate and the maternal liver function were normal. One infant was delivered in GW 34 on maternal indication and the rest in full term. No gross malformations were noted. All infants received antiretroviral prophylaxis and have tested negative on follow-up. No increased maternal or infant morbidity was detected in this retrospective study of dolutegravir during pregnancy. This is so far one of the largest observational studies of dolutegravir treatment during pregnancy, but the number is indeed small, and further studies are needed to evaluate the safety and efficacy.
新的抗 HIV 药物的发展提高了治疗效果和生活质量，同时减少了 HIV 感染者的不良反应。整合酶抑制剂多替拉韦在短时间内成为许多国家一线治疗的一部分，但不是妊娠推荐的一线药物。由于关于妊娠期间使用多替拉韦的出版物较少，我们发现分析斯德哥尔摩妊娠队列很有价值。这是一项对 2014 年 8 月至 2017 年在卡罗林斯卡大学医院接受多替拉韦治疗的所有孕妇及其婴儿的回顾性分析。收集了关于母亲健康、治疗、妊娠和儿童结局的信息。共纳入 36 例单胎妊娠妇女。4 例早期自然流产，1 例晚期流产，1 例失访。14 例在妊娠前使用多替拉韦，22 例在妊娠期间开始使用。18 例行剖宫产，其中 3 例因 HIV RNA > 50 拷贝/ml。子痫前期发生率和母体肝功能正常。1 例因母亲原因在 GW 34 分娩，其余均足月分娩。未发现明显畸形。所有婴儿均接受了抗逆转录病毒预防治疗，随访结果均为阴性。在这项回顾性研究中，未发现多替拉韦在妊娠期间使用会增加母婴发病率。这是迄今为止关于妊娠期间多替拉韦治疗的最大规模观察性研究之一，但数量确实较少，需要进一步研究评估其安全性和疗效。
