PrEP-C: A Risk Reduction Strategy For HIV– Women with HIV+ Partners
Stephen Taylor*1, J Whetham2, C McInnes1, L Charlewood2, E Payne1, T Kieth2, R Howell2, J Home1, D White1, and Y Gilleece2
1Birmingham Heartlands Hosp, UK and 2Brighton and Sussex Univ Hosp NHS Trust, Brighton, UK
Background: Serodiscordant couples (male HIV+, female HIV–) wishing to conceive present complex management issues. Sperm washing is a well-established technique, but many couples cannot afford or access it. The desire to have biological children may lead couples to make uninformed decisions about conception without understanding HIV transmission risks. We established 2 dedicated multidisciplinary preconception services for HIV+ individuals and their partners to discuss conception options. We present the data for couples choosing pre-exposure prophylaxis for conception (PrEP-C) as part of an overall pre-conception risk reduction strategy.
Methods: Couples were counseled together and individually prior to program entry. Detailed written informed consent outlining the risk benefits of PrEP-C was obtained. Data were collected on patient demographics, CD4, HIV viral load, and ARV history. Men underwent baseline semen analysis and seminal HIV viral load testing. Women had full fertility screens including tubal patency assessments. All couples used timed ovulatory intercourse to reduce exposure to HIV. Cycle length and ovulation (natural or stimulated) was determined by ovulation predictor kits or follicular tracking. Both partners were screened for sexually transmitted infections. The women took tenofovir ± emtricitabine at protocol-designated times before and after timed ovulatory intercourse. All women had HIV and pregnancy tests >17 days following each PrEP cycle.
Results: Of the 29 couples who have entered the PrEP-C program, to date 7 couples have completed more than 1 cycle of PrEP–C. A further 6 couples are progressing through the PrEP-C program. Median age for men is 41years (39 to 56) and women 35 years (28 to 43). Median CD4 count was 523 (236 to 1194) cells/mm3 and HIV viral load was <40 copies/mL in all men. Seminal plasma viral load was <200 copies/mL at baseline. To date there have been 5 pregnancies among 7 couples, resulting in 2 live births (no congenital defects, normal development), 1 ongoing twin pregnancy, and 2 miscarriages (6 of 40 +10 of 40) after a median of 3 PrEP-C cycles (1 to 5). There have been no HIV transmissions. PrEP-C was well tolerated with no discontinuations.
Conclusions: This is the first UK data on successful PrEP-C, undertaken in 2 dedicated HIV preconception clinics using a standardized PrEP-C protocol. Early data suggest that this may be a viable alternative to sperm washing in male HIV+–female HIV– couples wishing to conceive.