{"doi":"10.1056/nejmoa2200600","title":"Dolutegravir in Pregnancy as Compared with Current HIV Regimens in the United States","abstract":"BACKGROUND: Data on the effectiveness and safety of dolutegravir-based antiretroviral therapy (ART) for human immunodeficiency virus type 1 (HIV-1) infection in pregnancy as compared with other ART regimens commonly used in the United States and Europe, particularly when initiated before conception, are limited. METHODS: We conducted a study involving pregnancies in persons with HIV-1 infection in the Pediatric HIV/AIDS Cohort Study whose initial ART in pregnancy included dolutegravir, atazanavir-ritonavir, darunavir-ritonavir, oral rilpivirine, raltegravir, or elvitegravir-cobicistat. Viral suppression at delivery and the risks of infants being born preterm, having low birth weight, and being small for gestational age were compared between each non-dolutegravir-based ART regimen and dolutegravir-based ART. Supplementary analyses that included participants in the Swiss Mother and Child HIV Cohort Study were conducted to improve the precision of our results. RESULTS: Of the pregnancies in the study, 120 were in participants who received dolutegravir, 464 in those who received atazanavir-ritonavir, 185 in those who received darunavir-ritonavir, 243 in those who received rilpivirine, 86 in those who received raltegravir, and 159 in those who received elvitegravir-cobicistat. The median age at conception was 29 years; 51% of the pregnancies were in participants who started ART before conception. Viral suppression was present at delivery in 96.7% of the pregnancies in participants who received dolutegravir; corresponding percentages were 84.0% for atazanavir-ritonavir, 89.2% for raltegravir, and 89.8% for elvitegravir-cobicistat (adjusted risk differences vs. dolutegravir, -13.0 percentage points [95% confidence interval {CI}, -17.0 to -6.1], -17.0 percentage points [95% CI, -27.0 to -2.4], and -7.0 percentage points [95% CI, -13.3 to -0.0], respectively). The observed risks of preterm birth were 13.6 to 17.6%. Adjusted risks of infants being born preterm, having low birth weight, or being small for gestational age did not differ substantially between non-dolutegravir-based ART and dolutegravir. Results of supplementary analyses were similar. CONCLUSIONS: Atazanavir-ritonavir and raltegravir were associated with less frequent viral suppression at delivery than dolutegravir. No clear differences in adverse birth outcomes were observed with dolutegravir-based ART as compared with non-dolutegravir-based ART, although samples were small. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and others.).","journal":"New England Journal of Medicine","year":2022,"id":243379,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":34,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9578,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2022-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":450607,"name":"Yanling Huo","orcid":null,"position":1,"is_corresponding":false},{"id":296936,"name":"Jennifer Jao","orcid":null,"position":2,"is_corresponding":false},{"id":503005,"name":"Kathleen M. Powis","orcid":"0000-0002-4478-4471","position":3,"is_corresponding":false},{"id":368526,"name":"Paige L. Williams","orcid":"0000-0002-7160-574X","position":4,"is_corresponding":false},{"id":318047,"name":"Deborah Kacanek","orcid":"0000-0002-4877-2646","position":5,"is_corresponding":false},{"id":428487,"name":"Lynn M. Yee","orcid":"0000-0002-6274-0544","position":6,"is_corresponding":false},{"id":405746,"name":"Ellen G. Chadwick","orcid":null,"position":7,"is_corresponding":false},{"id":346849,"name":"Stephanie Shiau","orcid":"0000-0003-2944-3406","position":8,"is_corresponding":false},{"id":428484,"name":"Denise L. Jacobson","orcid":"0000-0002-5896-7148","position":9,"is_corresponding":false},{"id":435842,"name":"Sean S. Brummel","orcid":"0000-0002-4116-404X","position":10,"is_corresponding":false},{"id":875742,"name":"Leila Sultan‐Beyer","orcid":null,"position":11,"is_corresponding":false},{"id":459815,"name":"Christian R. Kahlert","orcid":"0000-0002-0784-3276","position":12,"is_corresponding":false},{"id":267668,"name":"Rebecca Zash","orcid":"0000-0001-5707-421X","position":13,"is_corresponding":false},{"id":382517,"name":"George R. Seage","orcid":"0000-0001-5657-2970","position":14,"is_corresponding":false},{"id":382511,"name":"Kunjal Patel","orcid":"0000-0003-0002-681X","position":0,"is_corresponding":true}],"reference_count":23,"raw_metadata":null,"created_at":"2026-07-19T00:23:16.032700Z","pmid":"36053505","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}