Natural conception in HIV-serodiscordant couples with the infected partner in suppressive antiretroviral therapy

Romero, Jorge del; Baza, María Begoña; Río, Isabel; Jerónimo, Adrián; Vera, Mar; Hernando, Victoria; Rodrı́guez, Carmen; Castilla, Jesús

doi:10.1097/md.0000000000004398

Cited by 24 publications

(20 citation statements)

References 27 publications

(30 reference statements)

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“…The AIDS induced death rate is assume to be d = 1 based on [39]. Two cases are considered: η C = 0.04, based on a research study known as HPTN 052, where it is found that the risk of HIV transmission among heterosexual serodiscordant couples is 96% lower when the HIV-positive partner is on treatment [9]; and η C = 0.015, which means that HIV-infected individuals under ART treatment have a very low probability of transmitting HIV, based on [11]. For (1) fitting the total population of Cape Verde between 1987 and 2014 [25,42].…”

Section: 2mentioning

confidence: 99%

“…However, not all people living with HIV who take HIV treatment and have an undetectable viral load in the blood also have an undetectable viral load in their other bodily fluids: see, e.g., [22] and references therein. In our paper, the values considered for the modification parameters are based on two different research studies: the first one is known as HPTN 052, where it was found that the risk of HIV transmission among heterosexual serodiscordant couples is 96% lower when the HIV-positive partner is on treatment [9]; and the other one, where it was proved that HIV-infected individuals under ART treatment have a very low probability (assumed inferior to 0.04) of transmitting HIV [11]. We prove the global stability of the endemic equilibrium and we provide numerical simulations, illustrating the calibration of the model to the HIV/AIDS situation in Cape Verde.…”

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confidence: 99%

“…We have proved the global stability of the endemic equilibrium point of the SICA model for HIV/AIDS transmission proposed in [30], in the case where the AIDS-induced death rate is negligible. Two different values for the relative infectiousness of HIV-infected individuals under ART treatment were considered, based on the studies reported in [9,11] (η C = 0.04 and η C = 0.015) and two values for the relative infectiousness of HIV-infected individuals with AIDS symptoms (η A = 1.3 and η A = 1.35), based in [37]. We have shown that taking the parameter values given in Table 2, the SICA model describes well the cumulative cases of infection by HIV and AIDS in Cape Verde for the period from 1987 to 2014 [25,42].…”

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confidence: 99%

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Modeling and optimal control of HIV/AIDS prevention through PrEP

Silva¹,

Torres²

2018

Discrete &Amp; Continuous Dynamical Systems - S

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Pre-exposure prophylaxis (PrEP) consists in the use of an antiretroviral medication to prevent the acquisition of HIV infection by uninfected individuals and has recently demonstrated to be highly efficacious for HIV prevention. We propose a new epidemiological model for HIV/AIDS transmission including PrEP. Existence, uniqueness and global stability of the disease free and endemic equilibriums are proved. The model with no PrEP is calibrated with the cumulative cases of infection by HIV and AIDS reported in Cape Verde from 1987 to 2014, showing that it predicts well such reality. An optimal control problem with a mixed state control constraint is then proposed and analyzed, where the control function represents the PrEP strategy and the mixed constraint models the fact that, due to PrEP costs, epidemic context and program coverage, the number of individuals under PrEP is limited at each instant of time. The objective is to determine the PrEP strategy that satisfies the mixed state control constraint and minimizes the number of individuals with pre-AIDS HIV-infection as well as the costs associated with PrEP. The optimal control problem is studied analytically. Through numerical simulations, we demonstrate that PrEP reduces HIV transmission significantly.Comment: This is a preprint of a paper whose final and definite form is with 'Discrete and Continuous Dynamical Systems -- Series S' (DCDS-S), ISSN 1937-1632 (print), ISSN 1937-1179 (online), available at [https://www.aimsciences.org/journals/home.jsp?journalID=15]. In this version, typos detected while reading the proofs were correcte

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Section: 2mentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Modeling and optimal control of HIV/AIDS prevention through PrEP

Silva¹,

Torres²

2018

Discrete &Amp; Continuous Dynamical Systems - S

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“…This suggests that natural conception is relatively safe without PrEP use when timed intercourse is employed in HIV-1serodiscordant couples with a virally suppressed HIVpositive partner. Natural conception without PrEP has also been analyzed in other studies [8,15].…”

Section: Discussionmentioning

confidence: 99%

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

Sun

et al. 2020

BMC Infect Dis

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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.

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“…Indeed, there are no reported cases of penile–vaginal transmission in the setting of an undetectable viral load [ 7 ]. Both prospective cohort and modelling studies suggest that antiretroviral therapy for partners living with HIV combined with genital tract infection screening and condomless sex limited to peak fertility maximizes the likelihood of pregnancy while minimizing, or eliminating, sexual HIV transmission [ 8 , 9 ]. For individuals or couples who desire additional protection, or when partners living with HIV take ART inconsistently, pre-exposure prophylaxis (PrEP) offers a safe and highly effective method to reduce HIV acquisition risk while allowing for conception [ 10 ].…”

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confidence: 99%