It’s official: Dolutegravir is the preferred antiretroviral for women with HIV who are trying to conceive. For HIV-negative women, that designation goes to Truvada pre-exposure prophylaxis (PrEP).

These are the key recommendations in the December 2020 update to the Department of Health and Human Services’ Recommendations for the Use of Antiretroviral Drugs in Pregnant Women with HIV Infection and Interventions to Reduce Perinatal HIV Transmission in the United States.

The update recognizes new findings out of Botswana showing that dolutegravir (sold alone as Tivicay and included in the Triumeq, Dovato and Juluca single-tablet regimens) is far less likely than suspected based on earlier data to result in neural tube defects among infants born to women who used the medication around the time of conception. This moves dolutegravir from an alternative to the preferred option.

For HIV-negative women looking to become pregnant with HIV-positive partners, the guidelines list Truvada (tenofovir disoproxil fumarate/emtri-citabine) as the recommended PrEP-ception option across the reproductive life cycle, from preconception to breast feeding. Descovy (tenofovir alafenamide/emtracitabine) isn’t a preferred option because the FDA approval of Descovy for PrEP excludes people exposed to HIV through vaginal sex.