Approximately half of HIV-discordant heterosexual couples in the United States want
children. Oral antiretroviral preexposure prophylaxis, if effective in reducing heterosexual
HIV transmission, might be an option for discordant couples wanting to conceive. Couples
should receive services to ensure they enter pregnancy in optimal health and receive
education about all conception methods that reduce the risk of HIV transmission. In
considering whether preexposure prophylaxis is indicated, the question is whether
it contributes to lowering risk in couples who have decided to conceive despite known
risks. If preexposure prophylaxis is used, precautions similar to those in the current
heterosexual preexposure prophylaxis trials would be recommended, and the unknown
risks of preexposure prophylaxis used during conception and early fetal development
should be considered. Anecdotal reports suggest that oral preexposure prophylaxis
use is already occurring. It is time to have open discussions of when and how preexposure
prophylaxis might be indicated for HIV-discordant couples attempting conception.
Key words
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References
- Fertility desires and intentions of HIV-positive men and women.Fam Plann Perspect. 2001; 33 (165): 144-152
- HIV prevalence estimates–United States, 2006.MMWR. 2008; 57: 1073-1076
- Understanding the motivations, concerns, and desires of human immunodeficiency virus 1-serodiscordant couples wishing to have children through assisted reproduction.Obstet Gynecol. 2003; 101: 987-994
- Is natural conception a valid option for HIV-serodiscordant couples?.Hum Reprod. 2007; 22: 2353-2358
- Reproductive options for HIV-serodiscordant couples.AIDS Rev. 2006; 8: 13
- Double binds and the reproductive and mothering experiences of HIV-positive women.Qual Health Res. 2000; 10: 117-132
- Human immunodeficiency virus and fertility care: embarking on a path of knowledge and access.Fertil Steril. 2006; 85: 298-300
- Infertility treatment for HIV-positive women.Women Health. 2008; 4: 15
- Restricting access of human immunodeficiency virus (HIV)-seropositive patients to infertility services: a legal analysis of the rights of reproductive endocrinologists and of HIV-seropositive patients.Fertil Steril. 2007; 88: 1483-1490
- Fertility services for human immunodeficiency virus-positive patients: provider policy, practice, and perspectives.Fertil Steril. 2008; 89: 1154-1158
- Use of infertiltiy services in the United States: 1995.Fam Plan Perspect. 2000; 32: 132-137
- PrEP Resources.(Accessed Oct. 15, 2010)
- Preexposure chemoprophylaxis for HIV prevention in men who have sex with men.N Engl J Med. 2010; 363: 2587-2599
- Tenofovir disoproxil fumarate for prevention of HIV infection in women: a phase 2, double-blind, randomized, placebo-controlled trial.PLoS Clin Trials. 2007; 2: e27
- Reducing the risk of mother-to-child human immunodeficiency virus transmission: past successes, current progress and challenges, and future directions.Am J Obstet Gynecol. 2007; 197: S3-S9
- Recommendations to improve preconception health and health care—United States.MMWR. 2006; 55: 1-23
- Sexual transmission of HIV according to viral load and antiretroviral therapy: systematic review and meta-analysis.AIDS. 2009; 23: 1397-1404
- Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents.Department of Health and Human Services. December 1, 2009; (Accessed Oct. 15, 2010): 1-161
- HIV transmission in serodiscordant heterosexual couples.BMJ. 2010; 340: c2449
- Strategies for harm reduction among HIV-affected couples who want to conceive.AIDS Behav. 2009; 13: 5-11
- Pre-exposure prophylaxis and timed intercourse for HIV-discordant couples willing to conceive a child.(Accessed Oct. 22, 2010)
- Effect of coinfection with STDs and of STD treatment on HIV shedding in genital-tract secretions: systematic review and data synthesis.Sex Transm Dis. 2000; 27: 243-248
- The role of sexually transmitted diseases in HIV transmission.Nature Rev Microbiol. 2004; 2: 33-42
- Reproduction decision making for couples affected by HIV: a review of the literature.Top HIV Med. 2004; 12: 7
- Male circumcision for HIV prevention: from evidence to action?.AIDS. 2008; 22: 567-574
- Prevalence of circumcision and herpes simplex virus type 2 infection in men in the United States: the National Health and Nutrition Examination Survey (NHANES), 1999-2004.Sex Transm Dis. 2007; 34: 479-484
- Sperm washing, use of HAART and role of elective Caesarean section.Curr Opin Obstet Gynecol. 2004; 16: 465-470
- Safety and efficacy of sperm washing in HIV-1-serodiscordant couples where the male is infected: results from the European CREAThE network.AIDS. 2007; 21: 1909-1914
- Safety of sperm washing and ART outcome in 741 HIV-1-serodiscordant couples.Hum Reprod. 2007; 22: 772-777
- Increased risk of incident HIV during pregnancy in Rakai, Uganda: a prospective study.Lancet. 2005; 366: 1182-1188
- Acquiring human immunodeficiency virus during pregnancy and mother-to-child transmission in New York 2002-2006.Obstet Gynecol. 2010; 115: 1247-1255
- Narrative review: antiretroviral therapy to prevent the sexual transmission of HIV-1.Ann Intern Med. 2007; 146: 591-601
- Safety and efficacy of tenofovir in pregnant women.(Accessed Oct. 15, 2010)
- Genital tract, cord blood, and amniotic fluid exposures of seven antiretroviral drugs during and after pregnancy in HIV-1 infected women.Antimicrob Agents Chemother. 2009; 53: 2367-2374
- Pregnancy rates and outcomes among women on triple-drug ART.(Accessed Oct. 15, 2010)
- Adverse effects of tenofovir use in HIV-infected pregnant women and their infants.Ann Pharmacother. 2008; 42: 1581-1585
- Safety of agents used to prevent mother-to-child transmission of HIV: is there any cause for concern?.Drug Saf. 2007; 30: 203-213
- Antiretroviral Pregnancy Registry International Interim Report for 1 January 1989 through 31 January 2010.in: Registry Coordinating Center, Wilmington, NC2010 (Accessed Oct. 15, 2010)
- Tenofovir disoproxil fumarate in pregnancy and prevention of mother-to-child transmission of HIV-1: is it time to move on from zidovudine?.HIV Med. 2009; 10: 397-406
- Biological effects of short-term or prolonged administration of 9-[2-(phosphonomethoxy)propyl]adenine (tenofovir) to newborn and infant rhesus macaques.Antimicrob Agents Chemother. 2004; 48 (Erratum in: Antimicrob Agents Chemother 2005;48:2346): 1469-1487
- Chronic administration of tenofovir to rhesus macaques from infancy through adulthood and pregnancy: summary of pharmacokinetics and biological and virological effects.Antimicrob Agents Chemother. 2008; 52: 3144-3160
- The risk of HIV drug resistance following implementation of pre-exposure prophylaxis.Curr Opin Infect Dis. 2010; 23: 621-627
- HIV, transmitted drug resistance, and the paradox of preexposure prophylaxis.PNAS. 2010; 107: 12381-12386
- Antiretroviral postexposure prophylaxis after sexual, injection-drug use, or other nonoccupational exposure to HIV in the United States: recommendations from the U.S..MMWR. 2005; 54: 1-20
- Acute HIV infection; in Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents.Department of Health and Human Services. Dec. 1, 2009; (pp 84-7, Table 10) (Accessed Oct. 16, 2010): 1-161
- Acute HIV revisited: new opportunities for treatment and prevention.J Clin Invest. 2004; 113: 937-945
- Revised recommendations for HIV testing of adults, adolescents and pregnant women in health care settings.MMWR. 2006; 55: 1-17
- Assisted reproductive technology surveillance—United States, 2006.MMWR. 2009; 58: 1-25
- Female subfertility.Lancet. 2002; 360: 151-159
- The economic impact of assisted reproductive technology: a review of selected developed countries.Fertil Steril. 2009; 91: 2281-2294
- Rethinking the heterosexual infectivity of HIV-1: a systematic review and meta-analysis.Lancet Infect Dis. 2008; 8: 553-563
- Donor insemination and human immunodeficiency virus transmission.Obstet Gynecol. 1998; 91: 515-518
- HIV and reproductive care—a review of current practice.BJOG. 2006; 113: 869-878
- Modeling the impact of HIV chemoprophylaxis strategies among men who have sex with men in the United States: HIV infections prevented and cost-effectiveness.AIDS. 2008; 22: 1829-1839
- American physicians remain slow to embrace the reproductive needs of human immunodeficiency virus-infected patients.Fertil Steril. 2006; 85: 295-297
Article info
Publication history
Published online: April 01, 2011
Accepted:
February 8,
2011
Received in revised form:
January 20,
2011
Received:
November 18,
2010
Footnotes
The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.
Cite this article as: Lampe MA, Smith DK, Anderson GJE, et al. Achieving safe conception in HIV-discordant couples: the potential role of oral preexposure prophylaxis (PrEP) in the United States. Am J Obstet Gynecol 2011;204:488.e1-8.
Reprints not available from the authors.
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Published by Elsevier Inc.
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- Safer conception options for HIV-serodiscordant couplesAmerican Journal of Obstetrics & GynecologyVol. 206Issue 1
- PreviewIn the short time since publication of the review of Lampe et al1 of preexposure prophylaxis (PrEP) and other safer conception options for human immunodeficiency virus (HIV)-serodiscordant couples, results from 2 important studies have been released. These studies are significant additions to the landscape of safer conception options.
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