title: Pre-exposure prophylaxis for conception (PrEP-C) as a risk reduction strategy in HIV-positive men and HIV-negative women in the UK.
abstract: Couples wishing to have biological children when one partner is HIV positive and the other is HIV negative present clinicians with complex clinical, social and ethical considerations. We established two multidisciplinary pre-conception services for HIV-positive individuals and their partners. We report the first UK use of pre-exposure prophylaxis for conception (PrEP-C) as part of an overall risk reduction strategy. Couples were counselled and written informed consent for PrEP-C was obtained. Patient demographics, HIV and medical histories were recorded. Males underwent baseline semen analysis and seminal HIV viral load testing. Females had full fertility screens. Both partners were screened for sexually transmitted infections. All couples used timed ovulatory intercourse (TOI). Tenofovir±emtricitabine was taken by the female at protocol designated times before±after TOI. Thirty-two male positive/female negative couples used the services. Thirteen couples have used PrEP-C (median age of male 41 years (range 32-56), female 31 (28-43); median CD4 533 (236-1194); all male plasma and seminal HIV viral loads were undetectable). Eleven pregnancies in 10 couples have resulted in 7 live births, 1 ongoing pregnancy and 4 miscarriages (5/40, 6/40, 10/40 and 1 twin 17/40) after a median of 2.5 attempts (range 1-5). PrEP-C was well tolerated with no discontinuations and no HIV transmissions. These data suggest that PrEP-C is a safe and effective option for serodiscordant couples wishing to conceive; a standardised protocol has been developed; data collection via a central database is under way.
authors.affiliation: a Brighton & Sussex University Hospitals NHS Trust , Brighton , UK.
authors.forename: J
authors.initials: J
authors.lastname: Whetham
authors.forename: S
authors.initials: S
authors.lastname: Taylor
authors.forename: L
authors.initials: L
authors.lastname: Charlwood
authors.forename: T
authors.initials: T
authors.lastname: Keith
authors.forename: R
authors.initials: R
authors.lastname: Howell
authors.forename: C
authors.initials: C
authors.lastname: McInnes
authors.forename: E
authors.initials: E
authors.lastname: Payne
authors.forename: J
authors.initials: J
authors.lastname: Home
authors.forename: D
authors.initials: D
authors.lastname: White
authors.forename: Y
authors.initials: Y
authors.lastname: Gilleece
mesh_terms: D000225:Adenine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000068679:Emtricitabine; D005191:Family Characteristics; D005260:Female; D005298:Fertility; D018023:HIV Seronegativity / Q000187:drug effects*; D006679:HIV Seropositivity / Q000188:drug therapy / Q000635:transmission*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D063065:Organophosphonates / Q000008:administration & dosage*; D016742:Preconception Care / Q000379:methods*; D011247:Pregnancy; D011256:Pregnancy Outcome; D040242:Risk Reduction Behavior; D012661:Semen / Q000821:virology; D055101:Semen Analysis; D000068698:Tenofovir; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents; D063065:Organophosphonates; D003841:Deoxycytidine; D000068698:Tenofovir; D000068679:Emtricitabine; D000225:Adenine