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IAS 2013: PrEP in Women Trying to Conceive—Infected Male Partner Needs to be on ART

A group of US researchers presented a model that assessed the chances of an uninfected female partner remaining negative while trying to conceive. The assumption is that the male partner is HIV-positive and on treatment. They presented two scenarios: (1) optimal: unprotected sex acts limited to the "window of ovulation" and (2) suboptimal: unprotected sex acts not limited to the window of ovulation.

Here are their results from the abstract: "In both optimal and suboptimal scenarios, the HIV-1-infected partner being on ART has the greatest influence on HIV-1 transmission. The probability of the female remaining uninfected and conceiving is most influenced by female age (< 30 years), followed by male [taking] ART. On average, the annual probability of remaining HIV-uninfected and having a child increases with ART from 29.5% to 33.3% in the optimal case and from 16.5% to 31.7% in the suboptimal case. PrEP added to ART increases the probability in the optimal case from 33.3% to 33.5%, and in the suboptimal from 31.7% to 32.6."

The authors had the following conclusions:

-- PrEP for the uninfected female partner provides little added benefit when the HIV-1-infected male partner is on ART, unprotected sex is limited to the window of ovulation, and STIs are treated.

-- Younger female age reduces the risk of transmission by decreasing the number of unprotected sexual acts required for conception.

-- This model may be a useful tool to help couples understand risks of transmission during conception, and to allow couples and providers to better understand the role of female age and cost-benefit of PrEP for conception.

The session rapproteur wrote later about what he called the session's most interesting presention: “...Currently, the coverage of ART and PMTCT services in the northern hemisphere has reached higher levels, allowing HIV-infected or affected couples to safely plan pregnancies as per their fertility intentions. Correctly guiding HIV-infected or affected couples about their fertility choices is a major ethical issue and an important public health challenge."

Osoti A et al. The benefits of pre-exposure prophylaxis as an adjunctive method of HIV-1 prevention during attempted conception between HIV-1-uninfected women and HIV-1-infected male partners: a modeling approach.
Presented July 2, 2013 at IAS 2013 in Kuala Lumpur, Malaysia. Abstract TUAC0104.

Source: Reporting from Kuala Lumpur for the PRN News: Bill Valenti, MD