Safe conception for human immunodeficiency virus–discordant couples: the preexposure prophylaxis for conception alternative

Carli, Gabriella De; Palummieri, Antonio; Liuzzi, Giuseppina; Puro, Vincenzo

doi:10.1016/j.ajog.2013.08.011

Cited by 5 publications

(1 citation statement)

References 3 publications

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“…Now that antiretrovirals are widely recognized as powerful and recommended HIV prevention strategies, they provide a more accessible and affordable option to HIV-affected couples with normal fertility that desire pregnancy. In addition, since conception with medically assisted techniques (including sperm washing) requires careful observation of the menstrual cycle and pre-conception fertility workups, these options may actually prolong the time to conception for couples with normal fertility and their availability is limited in lower resource settings (11,12). Nonetheless, a substantial proportion of couples reported experience with these techniques and/or self-insemination and they remain important services to promote with realistic expectations of success rates and costs, when they align with couple preferences (13).…”

Section: Discussionmentioning

confidence: 99%

Fertility Intentions, Pregnancy, and Use of PrEP and ART for Safer Conception Among East African HIV Serodiscordant Couples

et al. 2017

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African HIV serodiscordant couples often desire pregnancy, despite sexual HIV transmission risk during pregnancy attempts. Pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART) reduce HIV risk and can be leveraged for safer conception but how well these strategies are used for safer conception is not known. We conducted an open-label demonstration project of the integrated delivery of PrEP and ART among 1013 HIV serodiscordant couples from Kenya and Uganda followed quarterly for 2 years. We evaluated fertility intentions, pregnancy incidence, the use of PrEP and ART during peri-conception, and peri-conception HIV incidence. At enrollment, 80% of couples indicated a desire for more children. Pregnancy incidence rates were 18.5 and 18.7 per 100 person years among HIV-uninfected and HIV-infected women, and higher among women who recently reported fertility intention (adjusted odds ratio 3.43, 95% CI 2.38-4.93) in multivariable GEE models. During the 6 months preceding pregnancy, 82.9% of couples used PrEP or ART and there were no HIV seroconversions. In this cohort with high pregnancy rates, integrated PrEP and ART was readily used by HIV serodiscordant couples, including during peri-conception periods. Widespread scale-up of safer conception counseling and services is warranted to respond to strong desires for pregnancy among HIV-affected men and women.

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Section: Discussionmentioning

confidence: 99%