Women at Risk for HIV Open to PrEP

Women at risk for infection with human immunodeficiency virus (HIV) frequently choose to use pre-exposure prophylaxis (PrEP) for HIV prevention when offered during preconception and pregnancy, according to a new study.

The results highlight that PrEP, a safe, highly effective method to prevent HIV infection, should be available to women regardless of their pregnancy status and that clinicians need to make HIV risk assessments a routine part of preconception and pregnancy care.

Women and their babies face higher risks of HIV during periconception, pregnancy, and postpartum periods. To help identify gaps in HIV prevention services for women who were at substantial risk for HIV preconception, researchers led by Dominika L. Seidman, MD, from the University of California, San Francisco, performed chart reviews on women who were identified as “at significant risk” for HIV acquisition preconception (women desiring pregnancy) and during pregnancy and lactation at 2 medical centers in San Francisco and New York from 2010 to 2015. The median time from identification as “at substantial risk” to consultation was 30 days.

The researchers identified 27 women, median age 27 years; 26 women had a male partner living with HIV, and 1 woman had a male partner who had sex with men. About three-fourths of the 26 women were receiving antiretroviral therapy, 42% had documented viral suppression, 39% had known detectable virus, and 19% had unknown viral loads.

About one-third of the women were identified preconception. The majority of the women were identified during pregnancy at a median gestational age of 20 weeks. One woman was identified in the postpartum period. None of the pregnant referrals had received safer conception counseling to reduce HIV transmission, the researchers noted.

One-fourth of the women were eligible for PrEP, and slightly more than half of them were offered PrEP. In 30%, the last HIV exposure was not assessed and PrEP was not offered.

Two-thirds of the women offered PrEP chose to take it, including 5 of 8 during preconception, 10 of 15 while pregnant, and 1 after delivery.

Median length of time on PrEP was 30 weeks. One-half of the women who were in care at delivery did not attend a postpartum visit. “Postpartum women are particularly vulnerable to loss-to-follow-up and miss opportunities for safe and effective HIV prevention,” the researchers stated.

One woman chose to stop PrEP after conception, and 6 discontinued PrEP after delivery for a variety of reasons. Eight women chose not to use PrEP, including 5 women who reported condom use, 5 who considered their partner’s HIV treatment adequate prevention, and 2 who planned to abstain during pregnancy and lactation.

The researchers acknowledged that “further research and education are needed to close critical gaps in screening for women who are at risk of HIV for pre- and post-exposure prophylaxis eligibility and gaps in care linkage before and during pregnancy and lactation.”

The researchers published their results online July 19, 2016 in the American Journal of Obstetrics & Gynecology.