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Role of Preexposure Prophylaxis in the Reproductive Health of Women at Risk for Human Immunodeficiency Virus Infection

Pollock, Lealah, MD, MS; Levison, Judy, MD, MPH

doi: 10.1097/AOG.0000000000002801
Current Commentary: PDF Only

Women in the United States and especially women of color continue to acquire human immunodeficiency virus (HIV) infection. During reproductive health visits, health care providers are ideally positioned to assess HIV risk and offer HIV prevention strategies, including preexposure prophylaxis (also known as “PrEP”), a once-daily fixed-dose combination of emtricitabine with tenofovir disoproxil fumarate approved by the U.S. Food and Drug Administration for use to prevent HIV acquisition in persons at risk. Family planning, pregnancy, and postpartum visits provide an opportunity to ask sensitive questions about sexual and reproductive health and to help women navigate preference-sensitive decisions, including an individualized plan for HIV prevention. Exposure to a fixed-dose combination of emtricitabine with tenofovir disoproxil fumarate during pregnancy and breastfeeding appears to be safe with respect to maternal and infant outcomes. This article reviews the critical issues, challenges, and opportunities when implementing preexposure prophylaxis for women at risk for HIV who are seeking family planning services or pregnancy or postpartum care.

Family planning, pregnancy, and postpartum visits provide an opportunity for health care providers to help women navigate preference-sensitive sexual and reproductive health decisions, including an individualized plan for human immunodeficiency virus prevention.

Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California; and the Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.

Corresponding author: Lealah Pollock, MD, MS, Department of Family and Community Medicine, University of California, San Francisco, 1001 Potrero Avenue, Building 22, San Francisco, CA 94110; email: Lealah.Pollock@ucsf.edu.

Financial Disclosure The authors did not report any potential conflicts of interest.

Funding from the Centers for Disease Control and Prevention was used for assistance with manuscript development and editing.

Each author has indicated that she has met the journal's requirements for authorship.

Received March 01, 2018

Received in revised form May 24, 2018

Accepted June 14, 2018

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.