First-lineTivicay
Dolutegravir
Integrase strand-transfer inhibitor (INSTI)
Preferred 3rd agent in HIV ART in pregnancy (WHO/BHIVA 2023).
Oral
First-line for
- HIV-1 treatment in pregnancy (with TDF/FTC backbone)
- Rapid viral load suppression for late-booking women
Mechanism
Inhibits HIV integrase → blocks proviral DNA integration into host genome.
“DTG — fast, potent, safe (with folate)”
- Earlier NTD signal disproven by Tsepamo follow-up
- Co-prescribe 5 mg folic acid preconception
Dosing
- Adult
- 50 mg PO OD
Contraindications
- AbsoluteDolutegravir hypersensitivity
- CautionCo-administration with metformin — ↑ levels
Side effects
- Insomnia, headache
- GI upset
- Weight gain (esp. with TAF)
- ↑ creatinine (tubular secretion block — not true GFR drop)
Fetal & maternal notes
- • Now first-line in pregnancy at any gestation (BHIVA 2023, WHO 2021)
- • Co-prescribe 5 mg folic acid
Key interactions
Polyvalent cations (Ca, Mg, Fe, Al)
CautionChelation → ↓ absorption — separate by 2 h
Rifampicin
Avoid↓ DTG levels — double dose
Metformin
Caution↑ metformin — cap at 1 g/day
Clinical pearls
- 💡 Rapid viral suppression — ideal for late presenters
- 💡 Take with or without food
Content last reviewed: REPLACE_ME (e.g. 2026-07)
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