Question - The article cited below notes “Neural-tube defects occur by the end of the sixth week of pregnancy (i.e. the fourth week after fertilization) and have been associated with exposure to specific drugs in pregnancy.” What newer antiretroviral agent (ARTs) has been posited to be associated with the development of neural-tube defects when used at the time of conception?
Answer - The cited article reports “A preliminary safety signal for neural tube defects” with regard to the antiretroviral drug dolutegravir. These authors concluded “The prevalence of neural tube defects was slightly higher in association with dolutegravir exposure at conception than with other types of ART exposure at conception (3 per 1000 deliveries vs 1 per 1000 deliveries). (Zash R. et.al. Neural-tube defects and antiretroviral treatment regimens in Botswana. 2019 NEJM 381(9):827-840)