Effectiveness of dolutegravir based antiretroviral treatment in preventing vertical transmission of HIV in West Bengal, India: A retrospective cohort study

Background Several antiretroviral regimens have been used for prevention of mother to child transmission (MTCT) of HIV, with maternal dolutegravir-based regimens (e.g. tenofovir/lamivudine/dolutegravir - TLD) being the latest, initiated in last 3–4 years. There is a need for assessment of effectiveness of this new regimen as compared to earlier efavirenz-based (tenofovir/lamivudine/efavirenz - TLE) and other regimens in program settings. Method We conducted this retrospective cohort study to determine effectiveness of the TLD regimen in preventing antenatal, intranatal and postnatal MTCT compared to earlier regimens. 1905 HIV-exposed infants in West Bengal, India from April 2017 to March 2023 with available polymerase chain reaction for HIV at 314 Integrated Counselling and Testing Centres were considered. Duration of antenatal antiretroviral treatment and infant feeding practices types were also analyzed. Results Among all mothers, 666 (35%) received TLD and 1194 (63%) TLE. With TLD, MTCT rate was significantly lower (2% vs 6.5%) [Adjusted Odds Ratio (AOR) = 0.28; 0.15–0.52] than all other regimens. Duration of maternal antiretroviral therapy (weeks) (AOR = 0.96; 0.95–0.98) and infant feeding practices (AOR = 0.09; 0.03–0.25) showed significant association with reduced MTCT rate. Conclusion Dolutegravir-based ART is more effective than earlier regimens and promises to achieve the elimination of pediatric HIV.