Note of caution on using DTG during the periconception period among women and adolescent girls of childbearing potential

• 1)Exposure to DTG at the time of conception may be associated with neural tube defects among infants.
• 2)DTG appears to be safe when started later in pregnancy: after the period of risk of neural tube defects and after the first trimester.
• 3)Adolescent girls and women of childbearing potential who do not currently want to become pregnant can receive DTG together with consistent and reliable contraception; hormonal contraception and DTG have no reported or expected drug–drug interactions although data are limited.
• 4)An EFV-based regimen is a safe and effective first-line regimen recommended for use by the WHO 2016 ARV guidelines and can be used among women of childbearing potential during the period of potential risk for developing neural tube defects (at conception and up to the end of first trimester)
• 5)Key considerations for national programmes when selecting the optimal ARV drug regimen for women and adolescent girls of childbearing potential include fertility levels, availability and coverage of contraceptives, pretreatment resistance to non-nucleoside reverse-transcriptase inhibitors at the population level, drug availability and the maternal and infant toxicity profile.
• 6)A woman-centred approach to health care should be taken that consciously adopts the perspectives of women and their families and communities, with care provided in ways that respect women’s autonomy in decision-making. Services must provide information and options to enable women to make informed choices.
• 7)This recommendation applies to all infants and children for whom an approved DTG dosing is available.
• 8)Because of limited long-term experience with DTG among both children and adults, active toxicity monitoring should be considered. WHO has developed specific guidance and tools (WHO implementation tool for monitoring the toxicity of new antiretroviral and antiviral medicines in HIV and viral hepatitis programmes. WHO, 2018 &http://www.who.int/tdr/research/tb_hiv/drug-safety-pregnancy/en/)..