Pre‐exposure prophylaxis forHIVprevention during pregnancy and lactation: forget not the women and children

Abstract

Summary Pregnancy is known to be a time of increased susceptibility to acquiring to human immunodeficiency virus (HIV) infection and this increased maternal risk places the unborn child at risk of vertical transmission. Pre‐exposure prophylaxis (PrEP) involves the provision of antiretroviral therapy to an HIV‐negative individual with ongoing risk of HIV exposure to limit the likelihood of HIV transmission. The inclusion of PrEP as part of a comprehensive strategy is recognised as an effective and safe means of reducing HIV infection in serodiscordant couples, thereby reducing the risk of vertical transmission of HIV. Current data suggest that PrEP is safe to continue during pregnancy and breastfeeding in HIV‐negative women who remain vulnerable to acquiring HIV. The recent Pharmaceutical Benefits Scheme subsidisation of PrEP has reduced the financial and practical obstacles of PrEP provision, and a subsequent increase in patient awareness and acceptance of PrEP is expected. The framework for appropriately identifying and managing at‐risk pregnant and lactating women requiring PrEP is poorly defined and warrants further clarification to better support clinicians and this patient group. This review discusses the current recommendations highlighting the gaps in the guidelines and makes some recommendations for future guideline development.

Pre‐Exposure Prophylaxis for HIV Infection and the Role of the Women's Health Care Provider in HIV Prevention

“…Individuals may be at an increased risk for HIV infection during pregnancy, and HIV transmission in pregnancy is associated with an increased risk of perinatal transmission, emphasizing the importance of HIV prevention during preconception and pregnancy. 22,40,41 The 2 clinical trials that demonstrated the efficacy of PrEP in women, the Partners Pre-Exposure Prophylaxis trial (Partners PrEP) and Botswana TDF2 Trial (TDF2), discontinued the use of PrEP among participants who incidentally became pregnant during the trials. 15,32,38 In the TDF2 trial, there was no difference in the rate of fetal loss (7.1% with TDF/FTC, 6.9% with placebo; P = 1.00) in early pregnancy between participants who received TDF/FTC compared with those who received placebo.…”

The Guttmacher– Lancet Commission on sexual and reproductive health and rights: how does Australia measure up?

“…The decrease in consistent condom use among gay and bisexual men since the introduction of pre‐exposure prophylaxis has led to an increase in the burden of bacterial STIs, particularly rectal chlamydia infections, and warrants attention . Pre‐exposure prophylaxis guidelines for pregnant and lactating women should also be prioritised to ensure that a range of safe and effective options are available to reduce the vertical transmission of HIV …”