PrEP case jean michel Molina

I  have  been  enjoying the  conference very much. a short session  on
PrEP- with 2 cases-
CASE 1 Discordant  couple HIV pos male, neg female wanting to be pregnant- him not yet on ART-
-enc partner to start ARV (This is more effective than PrEP) and cont using condoms, consider PrEP for her-PrEP-TDF alone risk reduction in women 71% in discordant couples when pos partner NOT on ARVs; if drug found in plasma, then inc efficacy to 80%; TasP more effective wth 96% reduction in linked transmissions.
HIV incidence was  0.2 per 100 yrs per person yrs when TasP and PrEP  used together 
Consider using condoms too;
-If they want a baby - and partner started on ARV but not yet fully suppressed- 
 could start PrEP-let them know that not yet fully studied in pregnancy, in real life, they present already pregnant' -does she need it? If partners VL is down to 60 copies/ml- depends on the risk they are prepared to take.
May take a bit longer til his VL undetectable and use PrEP
If parter has UDVL for 6 months, may not need PrEP to prevent infection, but if pt needs reassurance then can use PrEP 
HPTN 052 now has 5 yr follow up -93% reduction in incidence of linked transmissions. 
8 linked cases of linked infections- most early on day 35-84 after starting ART, no linked infection when HIV stably suppressed to <400copies/ml