HIV seroconversion during pregnancy and the need for pre-exposure prophylaxis (PrEP)

Carmen D Zorrilla,1 Fiorella Reyes Báez,1 Karolyn González Colón,2 Jessica Ibarra,2 Iris García,2 Ana M Mosquera2 1Obstetrics and Gynecology Department, University of Puerto Rico School of Medicine, San Juan, Puerto Rico; 2Maternal Infant Studies Center (C...

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Autores principales:	Zorrilla CD, Reyes Báez F, González Colón K, Ibarra J, García I, Mosquera AM
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2018
Materias:	PrEP Pregnancy HIV HIV sero-conversion Immunologic diseases. Allergy RC581-607
Acceso en línea:	https://doaj.org/article/f84c3d2b2f4c4af481d90e4b84d178f1
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spelling	oai:doaj.org-article:f84c3d2b2f4c4af481d90e4b84d178f12021-12-02T01:13:09ZHIV seroconversion during pregnancy and the need for pre-exposure prophylaxis (PrEP)1179-1373https://doaj.org/article/f84c3d2b2f4c4af481d90e4b84d178f12018-04-01T00:00:00Zhttps://www.dovepress.com/hiv-seroconversion-during-pregnancy-and-the-need-for-pre-exposure-prop-peer-reviewed-article-HIVhttps://doaj.org/toc/1179-1373Carmen D Zorrilla,1 Fiorella Reyes Báez,1 Karolyn González Colón,2 Jessica Ibarra,2 Iris García,2 Ana M Mosquera2 1Obstetrics and Gynecology Department, University of Puerto Rico School of Medicine, San Juan, Puerto Rico; 2Maternal Infant Studies Center (CEMI), Obstetrics and Gynecology Department, University of Puerto Rico School of Medicine, San Juan, Puerto Rico Abstract: The reduction in the mother-to-infant transmission of HIV has been among the early successes of care and treatment of women living with HIV. Prenatal HIV counseling and testing, the availability of diverse antiretroviral therapies, elective cesarean section, and the use of formula milk have significantly reduced the mother-to-infant transmission in the USA and Europe. We are presenting two cases of seroconversion during pregnancy, identified during labor and delivery, of women who received risk reduction counseling and serial HIV testing during pregnancy. Because there are no guidelines for (or easy access to) the use of pre-exposure prophylaxis (PrEP) in pregnancy, they were offered other strategies for prevention including risk reduction counseling, condoms, and serial HIV testing. These cases support the use of PrEP during pregnancy. Both infants were negative and the women are currently receiving long-term highly active antiretroviral therapy. One of them recently delivered another infant. After these two women seroconverted, we decided to offer PrEP to all pregnant women presenting for care who report having an HIV positive partner. During the period 2012–2014, we treated ten HIV negative pregnant women who were partners of HIV positive men. Since 2015, we have seen 20 pregnant women in HIV discordant relationships. Of those, seven received PrEP. No seroconversions have been observed among the pregnant women on PrEP. Although small numbers, seroconversion during pregnancy was observed in two of 13 (15%) of the pregnant women in HIV-discordant relationships seen in our clinic, excluding those treated with PrEP. Given the safety data and experience with tenofovir and emtricitabine among pregnant women living with HIV, we believe PrEP should be offered in pregnancy and that guidelines should reflect this option as an additional strategy to reduce risks during pregnancy and to further reduce infant HIV transmission risk. Keywords: PrEP, pregnancy, HIV, HIV seroconversionZorrilla CDReyes Báez FGonzález Colón KIbarra JGarcía IMosquera AMDove Medical PressarticlePrEPPregnancyHIVHIV sero-conversionImmunologic diseases. AllergyRC581-607ENHIV/AIDS: Research and Palliative Care, Vol Volume 10, Pp 57-61 (2018)
institution	DOAJ
collection	DOAJ
language	EN
topic	PrEP Pregnancy HIV HIV sero-conversion Immunologic diseases. Allergy RC581-607
spellingShingle	PrEP Pregnancy HIV HIV sero-conversion Immunologic diseases. Allergy RC581-607 Zorrilla CD Reyes Báez F González Colón K Ibarra J García I Mosquera AM HIV seroconversion during pregnancy and the need for pre-exposure prophylaxis (PrEP)
description	Carmen D Zorrilla,1 Fiorella Reyes Báez,1 Karolyn González Colón,2 Jessica Ibarra,2 Iris García,2 Ana M Mosquera2 1Obstetrics and Gynecology Department, University of Puerto Rico School of Medicine, San Juan, Puerto Rico; 2Maternal Infant Studies Center (CEMI), Obstetrics and Gynecology Department, University of Puerto Rico School of Medicine, San Juan, Puerto Rico Abstract: The reduction in the mother-to-infant transmission of HIV has been among the early successes of care and treatment of women living with HIV. Prenatal HIV counseling and testing, the availability of diverse antiretroviral therapies, elective cesarean section, and the use of formula milk have significantly reduced the mother-to-infant transmission in the USA and Europe. We are presenting two cases of seroconversion during pregnancy, identified during labor and delivery, of women who received risk reduction counseling and serial HIV testing during pregnancy. Because there are no guidelines for (or easy access to) the use of pre-exposure prophylaxis (PrEP) in pregnancy, they were offered other strategies for prevention including risk reduction counseling, condoms, and serial HIV testing. These cases support the use of PrEP during pregnancy. Both infants were negative and the women are currently receiving long-term highly active antiretroviral therapy. One of them recently delivered another infant. After these two women seroconverted, we decided to offer PrEP to all pregnant women presenting for care who report having an HIV positive partner. During the period 2012–2014, we treated ten HIV negative pregnant women who were partners of HIV positive men. Since 2015, we have seen 20 pregnant women in HIV discordant relationships. Of those, seven received PrEP. No seroconversions have been observed among the pregnant women on PrEP. Although small numbers, seroconversion during pregnancy was observed in two of 13 (15%) of the pregnant women in HIV-discordant relationships seen in our clinic, excluding those treated with PrEP. Given the safety data and experience with tenofovir and emtricitabine among pregnant women living with HIV, we believe PrEP should be offered in pregnancy and that guidelines should reflect this option as an additional strategy to reduce risks during pregnancy and to further reduce infant HIV transmission risk. Keywords: PrEP, pregnancy, HIV, HIV seroconversion
format	article
author	Zorrilla CD Reyes Báez F González Colón K Ibarra J García I Mosquera AM
author_facet	Zorrilla CD Reyes Báez F González Colón K Ibarra J García I Mosquera AM
author_sort	Zorrilla CD
title	HIV seroconversion during pregnancy and the need for pre-exposure prophylaxis (PrEP)
title_short	HIV seroconversion during pregnancy and the need for pre-exposure prophylaxis (PrEP)
title_full	HIV seroconversion during pregnancy and the need for pre-exposure prophylaxis (PrEP)
title_fullStr	HIV seroconversion during pregnancy and the need for pre-exposure prophylaxis (PrEP)
title_full_unstemmed	HIV seroconversion during pregnancy and the need for pre-exposure prophylaxis (PrEP)
title_sort	hiv seroconversion during pregnancy and the need for pre-exposure prophylaxis (prep)
publisher	Dove Medical Press
publishDate	2018
url	https://doaj.org/article/f84c3d2b2f4c4af481d90e4b84d178f1
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HIV seroconversion during pregnancy and the need for pre-exposure prophylaxis (PrEP)

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