Is PrEP necessary during natural conception in HIV-1-serodiscordant couples on ART with suppressed viral load? A retrospective cohort analysis

Abstract

Background: Antiretroviral therapy (ART) demonstrates high efficacy in reducing the risk of HIV transmission to sexual partners. However, it is not clear if the use of pre-exposure prophylaxis (PrEP) in HIV-1-serodiscordant couples is necessary during natural conception when the HIV-positive partner exhibits a suppressed viral load. The purpose of this study was to assess the role of PrEP during natural conception in this population. Methods: A retrospective, multicenter study was conducted in a cohort of HIV-1-serodiscordant couples (positive man, negative woman) with childbearing desires. HIV-positive male partners were treated with ART and achieved viral suppression for more than half a year. The HIV-negative female partners were either treated with PrEP or not treated with PrEP, and outcomes were compared between the two treatment groups. Results: Of 246 HIV-1-serodiscordant couples in whom the HIV-positive partner achieved viral suppression, 104 seronegative women were treated with PrEP during natural conception and 142 seronegative women were not treated with PrEP. There were 410 condom-less sexual acts in couples treated with PrEP and 615 condom-less sexual acts in couples not treated with PrEP. We observed no instances of HIV transmission in HIV-1-serodiscordant couples with or without the use of PrEP during the process of natural conception. Conclusions: Our results show that PrEP had minimal influence in reducing the risk of HIV transmission during natural conception in HIV-1-serodiscordant couples with a stably suppressed viral load. Thus, it may be an acceptable option for HIV-negative partners to not use PrEP during the process of natural conception if the HIV-positive partner has achieved viral suppression for more than half a year.

Communication Needs for Improved Uptake of Prep and HIVST Services Among Key Populations in Nigeria: A Mixed-Method Study

“…There have been multiple interventions to address the burden of HIV [1,7] as part of the strategy of reaching the UNAID's 95-95-95 goals -of having 95 of people living with HIV diagnosed, 95% of diagnosed on antiretroviral therapy (ART), and 95%% of treated virally suppressed by the year 2030 In Nigeria, despite the introduction of pre-exposure prophylaxis (PrEP) and HIV self-testing (HIVST) services in 2017 and 2018 respectively, there is reportedly low uptake of HIV prevention services among the KPs [8][9]. Factors related to cost, literacy, language, norm, culture, type of sex work, scheduling, individual and group behavioural patterns, risk perception, perceived relevance of interventions, contextual factors and norms, stigma and discrimination, and constant migration among the KP groups, continue to compound low uptake of the HIV prevention services [10][11][12][13][14]. Addressing these barriers requires institutionalizing an effective and well-implemented communication strategy.…”

Risk of Sexual Transmission of HIV with Antiretroviral Therapy and Variable or Suppressed Viral Load

“…18 The 14 primary studies were published between 2018 and 2022, all of which employed nonrandomized study designs. 13,14,[19][20][21][22][23][24][25][26][27][28][29][30] Seven of the nonrandomized studies used a prospective cohort design 13,14,19,[21][22][23]25 and 7 used a retrospective method. 20,24,[26][27][28][29][30]…”

“…Of these potentially relevant articles, 72 publications were excluded for various reasons, while 15 studies met the inclusion criteria and were included in this report. 13,14,[18][19][20][21][22][23][24][25][26][27][28][29][30] These comprised 1 overview of SRs and/or MAs, 18 and 14 nonrandomized studies. 13,14,[19][20][21][22][23][24][25][26][27][28][29][30] Appendix 1 presents the PRISMA 31 flow chart of the study selection.…”

“…13,14,[18][19][20][21][22][23][24][25][26][27][28][29][30] These comprised 1 overview of SRs and/or MAs, 18 and 14 nonrandomized studies. 13,14,[19][20][21][22][23][24][25][26][27][28][29][30] Appendix 1 presents the PRISMA 31 flow chart of the study selection.…”

“…32 Results of the 2 relevant SRs included in the overview are summarized in the current report. Of the 14 primary studies, 13,14,[19][20][21][22][23][24][25][26][27][28][29][30] only data describing characteristics and findings relevant to the current report were abstracted and summarized herein.…”