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WHO recommends once feared drug to treat HIV

Wednesday July 24 2019

Dolutegravir (DTG) is the anti-retroviral drug of choice for those living with HIV in developed countries. PHOTO | AFP

Dolutegravir (DTG) is the anti-retroviral drug of choice for those living with HIV in developed countries. PHOTO | AFP 

ANGELA OKETCH
By ANGELA OKETCH
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PAULINE KAIRU
By PAULINE KAIRU
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A drug that was previously feared to cause deformities in unborn children is now the preferred HIV treatment option.

The World Health Organisation (WHO) says women of reproductive age are included in the population.

NOTE OF CAUTION

The organisation says it is updating its HIV therapy guidelines to strengthen its recommendation for dolutegravir (DTG) drug as the first-line treatment because of its efficacy, tolerability and a high genetic barrier to resistance.

This decision, according to the WHO, was arrived at after considering mathematical models of the benefits and harm associated with two HIV drugs (dolutegravir and Efavirenz), the values and preferences of people with HIV as well as factors related to the implementation of HIV programmes in different countries and cost.

There had been fears about the risk of defects in the brain, spine or spinal cord being higher for babies of women on dolutegravir.

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As a result, countries like Kenya halted plans to make DTG-based regimens the preferred first-line therapy.

Results from several studies had issued a note of caution about the use of DTG by women of childbearing age.

This led to the Health ministry telling hospitals to stop prescribing the drug to HIV-positive women.

Through the then Director of Medical Services, Dr Jackson Kioko, the ministry in July 2018 directed county health bosses to ensure that pregnant and breastfeeding mothers to whom the drug DTG had been prescribed to continue their prescription until they stop breastfeeding.

FIRST-LINE TREATMENT

Those of childbearing age — between 15 and 49 years — who were on the drug, were to be given Efavirenz as the first-line treatment.

In a memo to county health directors, Dr Kioko said the drug, which was launched in the Kenyan market last year, was not recommended for pregnant and breastfeeding women “due to limited safety data”.

The order did not go down well with HIV-positive women, who went to court.

International Community of Women Living with HIV-Kenya vice-chairperson Patricia Asero said DTG was a drug they had been dreaming of accessing. “When the government decides on our behalf without consulting us, it’s denying us our fundamental rights,” she said.

“We take ARVs to suppress the virus and improve our health. Compared to Efavirenz, DTG has been shown to have better outcomes. It’s therefore unfair for the government to deny us the drug.”

 Experts and civil society groups have also disapproved of the decision to stop prescription of the drug to women.

“Initial research had highlighted a possible link between DTG and the defects in infants. This concern was reported in May 2018 from a study in Botswana,” WHO said on Monday.