Achieving Pregnancy While Minimizing HIV Transmission Risks

For those of you who see HIV affected couples who are considering pregnancy I attended an excellent symposium on the subject  yesterday.

Pietro Vernazza from Switzerland gave an overview on the science of safe conception strategies. Data from HTPN052 has obviously really transformed the information we can now give patients. We shouldn’t underestimate the power this news has for couples who believed they could never have a family or felt they were taking great risks if they tried.

 Nelly Mugo from Kenya spoke about her experiences in a study of close to 2000 serodiscordant couples using PrEP (Tenofovir and TDF/FTC). The study found no differences in pregnancy indcidence, preterm birth or infant growth in the first year of life when comparing the PrEP group with placebo. It is an important option for those women who’s partner has not yet started ART. Pietro Vernazza thought it was an unnecessary addition however for those women whose partners were on treatment even given the fact that these men may ocassionally have viral blips.

Elaine Abrams from Columbia University then discussed Unanswered Questions about ART and Pregnancy.  There were 1.5 million HIV infected pregnant women in 2014, with 1.3 million of those in subSaharan Africa. 73% of them were receiving ART. Important points were that since the change in WHO Guidelines in 2013 regarding the use of Efavirenz as first line ART in pregnant  women ( including those in the first trimester and women of child bearing age) there has been no subsequent uptick in the rates of congenital anomalies . This is reassuring and significant given the  hundreds of thousands of women who have taken it in the last couple of years.

Also, there have been approximately 18 large studies looking at ARVs and preterm birth. There does seem to be some association with prematurity but it is not severe. It appears to be mostly associated with PI use and if it is started preconception it seems to be associated with increased risk.

Can I bring to your attention the following website www.hiveonline.org. . Shannan Weber, the director of HIVE, a clinic in San Francisco which cares for HIV infected pregnant  women, gave a really inspiring and personal talk about some of the people she has assisted in having families. There are some great resources for patients on the website including a really practical one about Home Insemination.

TasP and PrEP have radically changed the experiences of those couples affected by HIV who want to have children. How great it is to be able to offer them such positive information.