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HIV in Pregnancy — SCE Infectious Diseases MCQ

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ModerateHIV MedicineHIV in PregnancySCE Infectious Diseases

A 29-year-old woman with HIV is planning conception. She is on Dolutegravir/Lamivudine (Dovato). Her CD4 is 680 cells/µL and VL <50 copies/mL. HBsAg is negative. She asks about the safety of continuing Dolutegravir in early pregnancy. What is the current evidence-based advice?

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Correct answer: E — Dolutegravir is safe to continue in pregnancy including the periconception period; the initial neural tube defect signal has not been confirmed in larger studies

The initial Tsepamo study signal suggesting increased neural tube defect risk with periconception Dolutegravir exposure has not been confirmed in larger datasets. Updated data show the risk is comparable to background rates. BHIVA 2025 pregnancy guidelines and WHO now recommend Dolutegravir as the preferred INSTI in pregnancy, including the periconception period. However, DTG/3TC dual therapy should be switched to triple ART in pregnancy for added safety margin unless there are compelling reasons to continue.

Reference: BHIVA 2025 – HIV in pregnancy guidelines; WHO 2022 – Updated recommendations on first-line ART