<scp>PrEP</scp> for women in Europe: a systematic literature review

Fitzgerald, Naomi; Coltart, Holly; Domínguez-Domínguez, Lourdes; Flanagan, Kate; Gilleece, Yvonne

doi:10.1111/hiv.13458

Cited by 2 publications

(1 citation statement)

References 63 publications

(118 reference statements)

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“…No transmissions occurred, but the latter case illustrates the need for PrEP access for pregnant and breastfeeding women at risk of acquiring HIV in all settings [ 25 , 37 ]. A recent systematic review highlighted the lack of data available to inform PrEP use for women in Europe during pregnancy and postpartum [ 38 ]. The inclusion in trials of the increasing number of women conceiving on LAI treatment or PrEP, alongside pharmacokinetic data during pregnancy and lactation is crucial [ 39 ].…”

Section: Policies and Clinical Studies In High-income Countriesmentioning

confidence: 99%

Infant feeding: emerging concepts to prevent HIV transmission

Bamford,

Foster,

Lyall

2023

Current Opinion in Infectious Diseases

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Purpose of review HIV screening in pregnancy, universal suppressive antiretroviral therapy (ART) and breastfeeding avoidance can almost completely prevent vertical transmission of HIV. Breastfeeding is associated with an additional risk of transmission, although this risk is extremely low with suppressive maternal ART. This minimal risk must be balanced with the benefits of breastfeeding for women living with HIV (WLHIV) and their infants. Guidance in high-income countries has evolved, moving towards supported breast feeding for women on suppressive ART. Recent findings Breastmilk transmission accounts for an increasing proportion of new infant infections globally. The majority of transmission data comes from studies including women not on suppressive ART. Breastmilk transmissions in the context of undetectable viral load have rarely occurred, although risk factors remain unclear. Outcome data on supported breastfeeding are accumulating, providing evidence for guidelines and informing infant feeding decisions. Long-acting ART for maternal preexposure prophylaxis or treatment, and infant postnatal prophylaxis are promising future options. Summary Breastfeeding on suppressive ART has a very low risk of vertical transmission and can have multiple benefits for WLHIV and their infants. However, caution is advised with relaxation of breastfeeding guidance so as not to jeopardise the global goal of elimination of vertical transmission by 2030.

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Section: Policies and Clinical Studies In High-income Countriesmentioning

confidence: 99%

Infant feeding: emerging concepts to prevent HIV transmission

Bamford,

Foster,

Lyall

2023

Current Opinion in Infectious Diseases

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Incidence and factors associated with PrEP discontinuation in France

Garofoli,

Siguier,

Robineau

et al. 2024

Journal of Antimicrobial Chemotherapy

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Objectives HIV pre-exposure prophylaxis (PrEP) is effective in preventing HIV, but some seroconversions occur due to poor adherence or PrEP discontinuation. Our objective was to estimate the incidence of PrEP discontinuation and describe the reasons and factors associated with discontinuations. Methods A retrospective cohort was conducted in three French hospitals between January 2016 and June 2022. PrEP users who attended at least twice within 6 months during study period were included and followed up until December 2022. The incidence rate of PrEP discontinuation was estimated by censoring lost to follow up individuals. Factors associated with PrEP discontinuations were identified using a multivariate Cox model. Results A total of 2785 PrEP users were included, with 94% men and 5% transgender people. Median age was 35 years. By December 2022, 653 users had stopped PrEP (24%). The incidence rate was 10.8 PrEP discontinuations for 100 person-years (PY). The main causes of discontinuation were being in a stable relationship (32%), and not judging the treatment useful anymore (12%). Individuals who discontinued PrEP were younger [<29, HR = 1.45 (1.17–1.80)], and more likely to be women [HR = 2.44 (1.50–3.96)] or sex workers [HR = 1.53 (0.96–2.44)]. They were more likely to report PrEP side effects [HR = 2.25 (1.83–2.77)] or ≥2 sexually transmitted infections [HR = 1.87 (1.53–2.27)] during the last year. Conclusion The incidence of PrEP discontinuations was quite low compared to rates observed in other cohorts. Users who stopped PrEP were sometimes still exposed to HIV, emphasizing the need for targeted interventions to prepare and support PrEP discontinuations and limit seroconversion risk.

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PrEP for women in Europe: a systematic literature review

Cited by 2 publications

References 63 publications

Infant feeding: emerging concepts to prevent HIV transmission

Infant feeding: emerging concepts to prevent HIV transmission

Incidence and factors associated with PrEP discontinuation in France

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