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

Area of Science:

• Infectious Diseases
• Public Health
• Obstetrics & Gynecology

Background:

• Mother-to-infant HIV transmission has significantly decreased due to prenatal care and antiretroviral therapies.
• However, seroconversion during pregnancy remains a concern, necessitating effective prevention strategies.
• Existing guidelines lack clear recommendations for pre-exposure prophylaxis (PrEP) use during pregnancy.

Purpose of the Study:

• To present cases of pregnancy-associated HIV seroconversion despite risk reduction counseling and testing.
• To evaluate the safety and efficacy of offering pre-exposure prophylaxis (PrEP) to pregnant women with HIV-negative partners.
• To advocate for updated guidelines including PrEP as a strategy to prevent mother-to-infant HIV transmission.

Main Methods:

• Case reports of two pregnant women who seroconverted during pregnancy, identified during labor and delivery.
• Implementation of a protocol offering PrEP to pregnant women with HIV-positive partners since 2015.
• Retrospective review of HIV-discordant pregnancies, comparing seroconversion rates with and without PrEP.

Main Results:

• Two cases of HIV seroconversion during pregnancy were identified, with both infants testing HIV-negative.
• Among 20 pregnant women in HIV-discordant relationships from 2015 onwards, seven received PrEP, with no observed seroconversions.
• Excluding those on PrEP, 2 of 13 (15%) pregnant women in HIV-discordant relationships experienced seroconversion.

Conclusions:

• These cases underscore the potential for HIV seroconversion during pregnancy, even with existing prevention measures.
• The findings support the use of pre-exposure prophylaxis (PrEP) during pregnancy, given its apparent safety and efficacy.
• Updated guidelines are recommended to incorporate PrEP as an additional tool to further reduce the risk of mother-to-infant HIV transmission.