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PrEP appears safe for use in conception, but may not be necessary if partner is taking treatment
Roger Pebody, 2013-07-04 07:00:00
HIV-negative women who wish to become pregnant with their male HIV-positive partner can be reassured that pre-exposure prophylaxis (PrEP) appears to be a safe option in terms of maternal and infant outcomes, according to data presented to the 7th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention in Kuala Lumpur on Wednesday.
But modelling work presented to the conference on Tuesday suggested that if the woman’s partner is already taking HIV treatment and unprotected sex is limited to her fertile days, then the addition of PrEP may not afford any extra benefit.
For couples in which one partner has HIV and the other does not (‘serodiscordant’ couples), it is increasingly recognised that effective antiretroviral therapy dramatically reduces the risk of HIV transmission. Moreover, unprotected sex can be limited to the days around ovulation (when conception is most likely to occur) – a very cheap HIV prevention intervention.
For couples in which the HIV-negative partner is male, another low cost intervention is the practice of self-insemination. However, when the HIV-negative partner is female, the expensive and intrusive process of sperm washing has generally been recommended.
Given the efficacy of pre-exposure prophylaxis in other situations, there has been discussion about the use of PrEP to assist conception, but little empirical data on its efficacy or safety, or recommendations on how to use it in practice.
The drugs which are used as PrEP, tenofovir and Truvada (tenofovir + FTC), are very widely used as antiretroviral therapy, including by pregnant women. Previous research has suggested that they have a similar safety profile to other antiretroviral drugs; infants born to mothers who took Truvada during pregnancy have not had slower growth or raised rates of congenital anomalies.
Nonetheless, the balance of risk and benefit is different when a drug is used by an individual who does not otherwise need the drug to control an existing infection or to prevent vertical transmission.
Moreover, an understanding of the safety of these drugs during pregnancy is also essential for the wider roll-out of PrEP to heterosexual women – those at highest risk for HIV infection are often of an age in which pregnancy is common.
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