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Pre‐exposure prophylaxis for HIV prevention during pregnancy and lactation: forget not the women and children
Author(s) -
Horgan Lisa,
Blyth Christopher C,
Bowen Asha C,
Nolan David A,
McLeanTooke Andrew P
Publication year - 2019
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/mja2.50052
Subject(s) - serodiscordant , pre exposure prophylaxis , breastfeeding , medicine , guideline , pregnancy , human immunodeficiency virus (hiv) , transmission (telecommunications) , family medicine , obstetrics , intensive care medicine , antiretroviral therapy , pediatrics , viral load , men who have sex with men , syphilis , pathology , biology , electrical engineering , genetics , engineering
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 (Pr EP ) 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 Pr EP 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 Pr EP 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 Pr EP has reduced the financial and practical obstacles of Pr EP provision, and a subsequent increase in patient awareness and acceptance of Pr EP is expected. The framework for appropriately identifying and managing at‐risk pregnant and lactating women requiring Pr EP 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.