Evaluating the Efficacy and Safety of Dolutegravir-Containing Versus Efavirenz-Containing Antiretroviral Therapy Regimens in HIV-1-Infected Pregnant Women and Their Infants

Inclusion Criteria

• Mother is able to provide written informed consent for her and her infant's participation in this study
• Mother has confirmed HIV-1 infection based on documented testing of two samples collected at different time points:
• Sample #1 may be tested using any of the following:
• Two rapid antibody tests from different manufacturers or based on different principles and epitopes
• One enzyme immunoassay (EIA) OR Western blot OR immunofluorescence assay OR chemiluminescence assay
• One HIV DNA polymerase chain reaction (PCR)
• One quantitative HIV RNA PCR (above the limit of detection of the assay)
• One qualitative HIV RNA PCR
• One total HIV nucleic acid test
• Sample #2 may be tested using any of the following:
• One rapid antibody test. If this option is used in combination with two rapid tests for Sample #1, at least one of the three rapid tests must be FDA-approved and the third rapid test must be from a third manufacturer or based on a third principle or epitope.
• One EIA OR Western blot OR immunofluorescence assay OR chemiluminescence assay
• One HIV DNA PCR
• One quantitative HIV RNA PCR (above the limit of detection of the assay)
• One qualitative HIV RNA PCR
• One total HIV nucleic acid test.
• See the protocol for more information on this inclusion criterion.
• At screening, mother is ART-naive, defined as having not received prior antiretroviral therapy other than ARVs received during prior pregnancies or prior periods of breastfeeding (i.e., receipt of any single, dual, or triple ARV regimen during prior time-limited periods of pregnancy and breastfeeding is permitted). Receipt of up to 14 days of ARVs during the current pregnancy is permitted prior to study entry so that initiation of ARVs during the current pregnancy is not delayed during the study screening period. Note: Non-study ART may be initiated in the current pregnancy prior to initiation of the study screening process. For eligible participants, enrollment must occur within 14 days of non-study ART initiation. Note: Receipt of ARVs during a prior pregnancy or prior period of breastfeeding must have concluded at least six months prior to study entry. Receipt of TDF or FTC/TDF for pre-exposure prophylaxis at any time in the past is not exclusionary (even if received within six months prior to study entry).
• At screening, mother has the following laboratory test results (based on testing of samples collected within 14 days prior to study entry):
• Grade 1 or lower (less than 2.5 times upper limit of normal [ULN]) alanine aminotransferase (ALT) and aspartate aminotransferase (AST)
• Grade 2 or lower (less than or equal to 1.8 times ULN) creatinine
• Grade 2 or lower (greater than or equal to 60 mL/min) estimated creatinine clearance (CrCl; Cockcroft-Gault formula). See the protocol for guidance on severity grading. Laboratory tests may be repeated during the study screening period, with the latest result used for eligibility determination.
• At screening and at study entry, no evidence of multiple gestation or fetal anomalies, as assessed by best available method
• At study entry, gestational age of 14-28 weeks, defined as greater than 13 weeks plus six days and less than 28 completed weeks gestation, estimated by best available method. Note: For this inclusion criterion and the previous inclusion criterion, fetal ultrasound is preferred but not required for purposes of eligibility determination. If ultrasound cannot be performed during the study screening period prior to study entry, it must be performed within 14 days after study entry. As further explained in the protocol, enrolled participants will not be withdrawn from the study based on ultrasound findings obtained after study entry.
• At study entry, mother expects to remain in the geographic area of the study site during pregnancy and for 50 weeks postpartum [Eligibility criteria added per Letter of Amendment 1 to V2; July 2018]:
• At study entry, mother reports that she does