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J Infect Dis. 2015 Nov 15;212(10):1534-43. doi: 10.1093/infdis/jiv305. Epub 2015 Jun 19.

Benefits of PrEP as an Adjunctive Method of HIV Prevention During Attempted Conception Between HIV-uninfected Women and HIV-infected Male Partners.

Author information

1
Department of Medicine, Division of Infectious Diseases, University of California, David Geffen School of Medicine, Los Angeles.
2
RAND Corporation, Santa Monica.
3
Department of Psychiatry and Behavioral Sciences, University of California, Center for Culture and Health, Los Angeles.

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.

KEYWORDS:

antiretroviral therapy; mathematical model; preexposure prophylaxis; safer conception

PMID:
26092856
PMCID:
PMC4621256
DOI:
10.1093/infdis/jiv305
[Indexed for MEDLINE]
Free PMC Article

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