HIV medication poses prescribing dilemma in poor countries

The recent discovery that an anti-HIV medication called dolutegravir can cause birth defects among pregnant women poses ethical challenges for doctors and patients in low-resource settings, according to reports.

Anti- HIV drug link to birth defect in women

An April 19, 2019 NPR article examined the dilemma between prescribing patients dolutegravir or giving them an older treatment drug called efavirenz, which is less effective than dolutegravir and may be associated with long-term health risks for the patient but is not associated with risk of birth defects.

Daniel Wikler, Mary B. Saltonstall Professor of Ethics and Population Health at Harvard T.H. Chan School of Public Health, said it would indefensible if poor countries developed policies that would give all women the older, less effective drug because they might get pregnant. “That would mean that some women are going to die because they’re at risk for pregnancy,” he said.

According to UNAIDS,

  • There were approximately 36.9 million people worldwide living with HIV/AIDS in 2017.
  • Of these, 1.8 million were children (<15 years old).
  • An estimated 1.8 million individuals worldwide became newly infected with HIV in 2017 – about 5,000 new infections per day. This includes 180,000 children (<15 years). Most of these children live in sub-Saharan Africa and were infected by their HIV-positive mothers during pregnancy, childbirth or breastfeeding.
  • Approximately 75% of people living with HIV globally were aware of their HIV status in 2017. The remaining 25% (over 9 million people) still need access to HIV testing services. HIV testing is an essential gateway to HIV prevention, treatment, care and support services.
  • The vast majority of people living with HIV are in low- and middle-income countries.

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