Many men and women living with HIV and their uninfected partners attempt to conceive children. HIV-prevention science can be applied to reduce sexual transmission risk while respecting couples’ reproductive goals. Here we discuss antiretrovirals as prevention in the context of safer conception for HIV-serodiscordant couples.
Antiretroviral therapy (ART) for the infected partner and pre-exposure prophylaxis (PrEP) for the uninfected partner reduce the risk of heterosexual HIV transmission. Several demonstration projects suggest the feasibility and acceptability of antiretroviral (ARV)s as periconception HIV-prevention for HIV-serodiscordant couples. The application of ARVs to periconception risk reduction may be limited by adherence.
For male-infected (M+F−) couples who cannot access sperm processing and female-infected (F+M−) couples unwilling to carry out insemination without intercourse, ART for the infected partner, PrEP for the uninfected partner, combined with treatment for sexually transmitted infections, sex limited to peak fertility, and medical male circumcision (for F+M couples) provide excellent, well tolerated options for reducing the risk of periconception HIV sexual transmission.
aMassachusetts General Hospital, Center for Global Health and Division of Infectious Disease; Beth Israel Deaconess Medical Center, Division of Infectious Diseases, Boston, USA
bDeputy Divisional Head, Maternal, Adolescent and Child Health Division (MatCH), University of the Witwatersrand, Durban, South Africa
cAlpert Medical School at Brown University, Obstetrics and Gynecology and Medicine, Providence
dUniversity of California at San Francisco, Department of Obstetrics, Gynecology and Reproductive Services, San Francisco, USA
Correspondence to Lynn T. Matthews, Assistant in Medicine, Massachusetts General Hospital, Center for Global Health and Division of Infectious Disease; Associate in Medicine, Beth Israel Deaconess Medical Center, Division of Infectious Diseases, 100 Cambridge Street, 15th Floor, Boston, MA 02114, USA. E-mail: firstname.lastname@example.org