title: PrEP as Peri-conception HIV Prevention for Women and Men.
abstract: Daily oral tenofovir (TDF)-based pre-exposure prophylaxis (PrEP) is an effective HIV prevention strategy and recommended for men and women with substantial risk of HIV acquisition. The peri-conception period, the stage prior to pregnancy when condom use is necessarily reduced, has elevated HIV risk that can be mitigated by PrEP use. Data from a randomized trial suggest that peri-conception PrEP use by HIV-seronegative women does not increase the risk of pregnancy loss, birth defects or congenital anomalies, preterm birth, or infant growth faltering. Women considering PrEP use throughout pregnancy must weigh the known increased risk of HIV acquisition with unknown risks of drug effects on infant growth. PrEP has been used safely by HIV-seronegative men with HIV-seropositive female partners who have become pregnant. As an effective user-controlled HIV prevention strategy, PrEP offers autonomy and empowerment for HIV prevention and can be recommended alongside antiretroviral therapy, fertility screening, vaginal self-insemination, intercourse timed to peak fertility, medically assisted reproduction, and other safer conception strategies to provide multiple options. The integration of PrEP into safer conception programs is warranted and will safely reduce HIV transmission to women, men, and children during the peri-conception period.
authors.affiliation: Departments of Global Health and Epidemiology, University of Washington, 325 Ninth Avenue, Box 359927, Seattle, WA, 98104, USA. rheffron@uw.edu.
authors.forename: Renee
authors.initials: R
authors.lastname: Heffron
authors.affiliation: School of Nursing, University of Washington, 325 Ninth Avenue, Box 359909, Seattle, WA, 98104, USA.
authors.forename: Jillian
authors.initials: J
authors.lastname: Pintye
authors.affiliation: Division of Infectious Disease and Center for Global Health, Massachusetts General Hospital, 125 Nashua Street, Suite 722, Boston, MA, 02114, USA.
authors.forename: Lynn T
authors.initials: LT
authors.lastname: Matthews
authors.affiliation: University of California San Francisco, 1001 Potrero Ave, 6D-33, San Francisco, CA, 94110, USA.
authors.forename: Shannon
authors.initials: S
authors.lastname: Weber
authors.affiliation: Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya.
authors.forename: Nelly
authors.initials: N
authors.lastname: Mugo
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D055118:Medication Adherence; D065129:Pre-Exposure Prophylaxis; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control*; D011295:Prenatal Care / Q000379:methods; D016032:Randomized Controlled Trials as Topic; D000068698:Tenofovir / Q000627:therapeutic use*; D014454:Uganda / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents; D000068698:Tenofovir
keywords: HIV prevention; Peri-conception; PrEP; Pre-exposure prophylaxis; Pregnancy; Review; Safer conception; Science of prevention