title: Benefits of PrEP as an Adjunctive Method of HIV Prevention During Attempted Conception Between HIV-uninfected Women and HIV-infected Male Partners.
abstract: BACKGROUND
  Data on effectiveness of preexposure prophylaxis (PrEP) for human immunodeficiency virus (HIV)-uninfected women attempting conception with HIV-infected male partners are limited to observational studies.
  
  
  METHODS
  To explore the benefits of PrEP for conception, we developed a model to estimate the average annual probability of a woman remaining HIV-uninfected and having a child ("successful" outcome) via condomless sex with an HIV-infected male. The outcome likelihood is dependent upon parameters defining HIV-1 infectivity. We simulated 2 scenarios: optimal (condomless sex acts limited to the ovulation window), and suboptimal (acts not limited to ovulation).
  
  
  RESULTS
  In the optimal scenario when the male is on antiretroviral therapy (ART), the average annual probability of the successful outcome is 29.1%, increasing to 29.2% with the addition of PrEP (P = .45). In the suboptimal scenario, the probability is 26.8% with ART alone versus 27.3% with ART/PrEP (P < .0001). Older maternal age reduces the probability of success in both scenarios, particularly after age 30.
  
  
  CONCLUSIONS
  In our model, PrEP provides little added benefit when the HIV-infected male partner is on ART, condomless sex is limited to the ovulation window, and other modifiable transmission risks are optimized. Older female age decreases the probability of success by increasing the number of condomless sex acts required for conception.
authors.affiliation: Department of Medicine, Division of Infectious Diseases, University of California, David Geffen School of Medicine, Los Angeles.
authors.forename: Risa M
authors.initials: RM
authors.lastname: Hoffman
authors.affiliation: RAND Corporation, Santa Monica.
authors.forename: Amber
authors.initials: A
authors.lastname: Jaycocks
authors.affiliation: RAND Corporation, Santa Monica.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Vardavas
authors.affiliation: RAND Corporation, Santa Monica.
authors.forename: Glenn
authors.initials: G
authors.lastname: Wagner
authors.affiliation: Department of Medicine, Division of Infectious Diseases, University of California, David Geffen School of Medicine, Los Angeles.
authors.forename: Jordan E
authors.initials: JE
authors.lastname: Lake
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of California, Center for Culture and Health, Los Angeles.
authors.forename: Deborah
authors.initials: D
authors.lastname: Mindry
authors.affiliation: Department of Medicine, Division of Infectious Diseases, University of California, David Geffen School of Medicine, Los Angeles.
authors.forename: Judith S
authors.initials: JS
authors.lastname: Currier
authors.affiliation: Department of Medicine, Division of Infectious Diseases, University of California, David Geffen School of Medicine, Los Angeles.
authors.forename: Raphael J
authors.initials: RJ
authors.lastname: Landovitz
mesh_terms: D000293:Adolescent; D000328:Adult; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D005260:Female; D005306:Fertilization; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission*; D006801:Humans; D008297:Male; D008875:Middle Aged; D065129:Pre-Exposure Prophylaxis / Q000379:methods*; D011247:Pregnancy; D016896:Treatment Outcome; D055815:Young Adult
keywords: antiretroviral therapy; mathematical model; preexposure prophylaxis; safer conception