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Pre‐exposure prophylaxis for HIV prevention during pregnancy and lactation: forget not the women and children

Lisa Horgan, Christopher C Blyth, Asha C Bowen, David A Nolan and Andrew P McLean‐Tooke
Med J Aust 2019; 210 (6): . || doi: 10.5694/mja2.50052
Published online: 1 April 2019

Summary

 

  • Pregnancy is known to be a time of increased susceptibility to acquiring to human immunodeficiency virus (HIV) infection and this increased maternal risk places the unborn child at risk of vertical transmission.
  • Pre‐exposure prophylaxis (PrEP) involves the provision of antiretroviral therapy to an HIV‐negative individual with ongoing risk of HIV exposure to limit the likelihood of HIV transmission.
  • The inclusion of PrEP as part of a comprehensive strategy is recognised as an effective and safe means of reducing HIV infection in serodiscordant couples, thereby reducing the risk of vertical transmission of HIV.
  • Current data suggest that PrEP is safe to continue during pregnancy and breastfeeding in HIV‐negative women who remain vulnerable to acquiring HIV.
  • The recent Pharmaceutical Benefits Scheme subsidisation of PrEP has reduced the financial and practical obstacles of PrEP provision, and a subsequent increase in patient awareness and acceptance of PrEP is expected.
  • The framework for appropriately identifying and managing at‐risk pregnant and lactating women requiring PrEP is poorly defined and warrants further clarification to better support clinicians and this patient group.
  • This review discusses the current recommendations highlighting the gaps in the guidelines and makes some recommendations for future guideline development.

 

  • Lisa Horgan1
  • Christopher C Blyth2
  • Asha C Bowen3,4
  • David A Nolan5
  • Andrew P McLean‐Tooke6

  • 1 Perth Children's Hospital, Perth, WA
  • 2 University of Western Australia, Perth, WA
  • 3 Princess Margaret Hospital for Children, Perth, WA
  • 4 Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA
  • 5 Royal Perth Hospital, Perth, WA
  • 6 PathWest Laboratory Medicine WA, Perth, WA


Competing interests:

No relevant disclosures.

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