PrEP as Peri-conception HIV Prevention for Women and Men

Heffron, Renee; Pintye, Jillian; Matthews, Lynn T.; Weber, Shannon; Mugo, Nelly

doi:10.1007/s11904-016-0312-1

Cited by 52 publications

(45 citation statements)

References 69 publications

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“…In PrEP as a bridge to ART strategy, PrEP is ofered to HIV-uninfected person as a 'bridge' to ART in the discordant partnership-that is, until ART initiation by the HIVinfected partner and for the irst 6 months after ART is started or viral suppression. This strategy demonstrated nearly elimination of HIV transmission within serodiscordant couples in Uganda and Kenya [29].…”

Section: Discussionmentioning

confidence: 99%

Anti-Retroviral–Based HIV Pre-Exposure Prophylaxis for Women: Recent Advances and Next Steps

Kiweewa¹,

Mugwanya²,

FrancisKiweewa³

2017

HIV/AIDS - Contemporary Challenges

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There is a daunting challenge to prevent human immunodeiciency virus (HIV) acquisition in women at high risk of acquiring HIV. Of the 37 million people globally living with HIV, more than half are women. Women account for nearly 60% of adults with HIV in sub-Saharan Africa, where unprotected heterosexual sex is the primary driver of the epidemic. While male condoms are efective, they are not always used, and this is not something women can control. Women urgently need prevention tools they can decide to use, independent of a husband or partner. Pre-exposure prophylaxis (PrEP), in which HIV-uninfected persons with ongoing HIV risk use antiretroviral (ARV) medications as chemoprophylaxis against sexual HIV acquisition, is a promising new HIV prevention strategy. We review recent advances in the development of new biomedical HIV prevention interventions with a highlight of indings from pivotal clinical trials, as well as a discussion on future generation strategies for women.

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Section: Discussionmentioning

confidence: 99%

Anti-Retroviral–Based HIV Pre-Exposure Prophylaxis for Women: Recent Advances and Next Steps

Kiweewa¹,

Mugwanya²,

FrancisKiweewa³

2017

HIV/AIDS - Contemporary Challenges

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“…Additionally, with the increasing popularity of integrase strand inhibitors (INSTIs) and recent FDA approval of tenofovir alafenamide (TAF), which is expected to have fewer side effects than TDF, the landscape of ART in pregnancy is likely to change again. Finally, there will be growing antiretroviral exposure among HIV-uninfected women with the use of pre-exposure prophylaxis (PrEP) [50]. …”

Section: In-utero Antiretroviral Therapy Exposurementioning

confidence: 99%

Surveillance monitoring for safety of in utero antiretroviral therapy exposures: current strategies and challenges

Zash

Williams

Sibiude

et al. 2016

Expert Opinion on Drug Safety

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Introduction The use of antiretroviral therapy (ART) in pregnancy to prevent vertical HIV transmission has been one of the most successful public health programs in the last decade. As a result, an unprecedented number of women are taking ART at conception and during pregnancy. Given few randomized studies evaluating safety of different ART regimens in pregnancy, ongoing drug safety surveillance is critical. Areas Covered This review aims to provide a rationale for ART drug safety surveillance, describe changing patterns of ART use and summarize current surveillance efforts in both low-resource and high-resource settings. Additionally, biostatistical approaches to and challenges in analysis of observational surveillance data are discussed. Expert Opinion The global landscape of ART use in pregnancy is rapidly increasing and evolving. Any increase in adverse effects of in-utero exposure to ART has the potential to reduce the impact of improvements in infant morbidity and mortality gained from decreased vertical HIV transmission. ART drug safety surveillance should therefore be a critical piece of programs to prevent mother to child transmission in both high- and low-resource settings. Current surveillance efforts could be strengthened with long-term follow-up of exposed children, pooling of data across cohorts and standardized approaches to analysis.

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“…However, PrEP trials excluded pregnant women from enrolment, and those who fell pregnant during these studies were discontinued from PrEP [11, 14]. A recent systematic review demonstrated that PrEP was not associated with increased pregnancy-related adverse events, and no studies have found adverse effects among infants exposed to tenofovir disoproxil fumarate (TDF) as part of treatment for HIV-infected women during pregnancy [15, 19–21] or breastfeeding [16, 22, 23]. In addition, our studies in South Africa demonstrated that the use of tenofovir during pregnancy was not associated with adverse events among infants [20, 21].…”

Section: Introductionmentioning

confidence: 99%

Delivering preexposure prophylaxis to pregnant and breastfeeding women in Sub-Saharan Africa

Davey

Bekker

Gorbach

et al. 2017

Aids

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HIV acquisition during pregnancy and postpartum periods remains high despite increased access to and initiation of antiretroviral therapy in sub-Saharan Africa. Moreover, maternal seroconversion during pregnancy and breastfeeding remains a source of significant paediatric HIV infection in the region. In order to curb vertical HIV transmission, HIV acquisition during pregnancy and lactation must significantly decline. Biological and behavioural factors contribute to high HIV incidence, including hormonal changes that alter genital mucosal surfaces, and frequent condomless sex with HIV-infected partners or partners of unknown serostatus. Pregnant and breastfeeding women who are at risk of HIV acquisition during pregnancy and lactation require female controlled interventions such as pre-exposure prophylaxis (PrEP) to prevent HIV acquisition during those particularly vulnerable periods. Before PrEP scale up for pregnant and lactating women, there is an urgent need for operations research to evaluate how best to provide PrEP to pregnant and breastfeeding women in settings of high HIV incidence. This should include how to: (1) integrate PrEP delivery and counselling into antenatal and postnatal care, (2) ensure optimal adherence during at-risk periods, and (3) target PrEP for maximum impact, including reaching pregnant and breastfeeding young women. In light of current knowledge on the safety of PrEP in pregnancy and breastfeeding, next steps are needed to ensure barriers to PrEP effectiveness are addressed.

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PrEP as Peri-conception HIV Prevention for Women and Men

Cited by 52 publications

References 69 publications

Anti-Retroviral–Based HIV Pre-Exposure Prophylaxis for Women: Recent Advances and Next Steps

Anti-Retroviral–Based HIV Pre-Exposure Prophylaxis for Women: Recent Advances and Next Steps

Surveillance monitoring for safety of in utero antiretroviral therapy exposures: current strategies and challenges

Delivering preexposure prophylaxis to pregnant and breastfeeding women in Sub-Saharan Africa

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