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Interactions between highly active antiretroviral therapy and over-the-counter agents: a cautionary note
  1. Jerome Federspiel1,2,
  2. Melanie J Bukhari2 and
  3. Matthew M Hamill3,4
  1. 1Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina, USA
  2. 2Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
  3. 3Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
  4. 4Sexual Health, Berkshire Healthcare NHS Foundation Trust, Slough, UK
  1. Correspondence to Dr Jerome Federspiel; jfederspiel{at}


Highly active antiretroviral therapy (HAART) has dramatically lowered rates of mother-to-child HIV transmission among patients with access to treatment. Barriers to complete viral suppression increase rates of transmission, even with only low levels of viral replication. Here, we present the case of a pregnant patient who developed a detectable viral load in pregnancy, thought to be related to calcium supplement consumption or emesis while using a dolutegravir-based HAART regimen. Ultimately, with adjustments, the patient again reached an undetectable viral load and had an uncomplicated perinatal and neonatal outcome. We discuss new data on the use of dolutegravir in pregnancy and precautions for maintaining viral suppression while on antiretroviral therapy in pregnancy.

  • pregnancy
  • HIV / AIDS

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  • Contributors Drs MJB and MMH originated the idea for the manuscript. Dr JF drafted the manuscript. Drs MJB and MMH reviewed the draft manuscript for important intellectual contributions.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.