Antiretroviral Medications Used Pre-Pregnancy in HIV Discordant Couples

Jared Baeten, MD PhD Professor, Departments of Global Health and Medicine Adjunct Professor, Department of Epidemiology University of Washington Seattle, WA 98104MedicalResearch.com Interview with:
Jared Baeten, MD PhD
Professor, Departments of Global Health and Medicine
Adjunct Professor, Department of Epidemiology
University of Washington
Seattle, WA 98104

Medical Research: What are the main findings of the study?

Dr. Baeten: Among heterosexual African couples in which the male was HIV positive and the female was not, receipt of antiretroviral pre-exposure preventive (PrEP) therapy did not result in significant differences in pregnancy incidence, birth outcomes, and infant growth compared to females who received placebo.

Medical Research: Were any of the findings unexpected?

Dr. Baeten: None of the findings were unexpected.   However, the results are new – this is the first study to assess systematically the safety of PrEP when used in the periconception period.

Medical Research: What should clinicians and patients take away from your report?

Dr. Baeten: In implementation of antiretroviral pre-exposure preventive as an HIV prevention strategy for heterosexual populations, pregnancies will occur.  Safe and effective HIV prevention options for women that do not require negotiations for safe sex and do not interfere with conception and pregnancy outcomes are a priority, and PrEP provides one such option.  Our findings provide additional evidence to support the use of periconception administration of antiretroviral PrEP for HIV-uninfected women in both high and low income populations, along with other strategies such as antiretroviral treatment of their HIV-infected partners and limiting unprotected sex to peak fertility periods to reduce the risk of sexual transmission of HIV.  These results should be discussed with HIV uninfected women receiving PrEP who are considering becoming pregnant.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Baeten: Additional research will be needed to assess the safety of PrEP when used throughout pregnancy.  In addition, for some of the outcomes in our study, including pregnancy loss, preterm birth, congenital anomalies, and infant mortality, confidence intervals were wide (suggesting uncertainty in the result),  and more study will continue to be needed.

Citation:

Pregnancy Incidence and Outcomes Among Women Receiving Preexposure Prophylaxis for HIV Prevention: A Randomized Clinical Trial

Nelly R. Mugo MBChB, MPH, Ting Hong MD, PhD, Connie Celum MD, MPH, Deborah Donnell PhD, Elizabeth A. Bukusi MBChB, PhD, Grace John-Stewart MD, PhD, Jonathan Wangisi MBChB, Edwin Were MBChB, MPH, Renee Heffron MPH, PhD, Lynn T. Matthews MD, MPH, Susan Morrison MD, MPH, Kenneth Ngure PhD, Jared M. Baeten MD, PhD

JAMA. 2014;312(4):362-371. doi:10.1001/jama.2014.8735

 

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