AIDS. 2010 Aug 24;24(13):1975-82. doi: 10.1097/QAD.0b013e32833bedeb.
HIV-serodiscordant couples face complicated choices between fulfilling reproductive desire and risking HIV transmission to their partners and children. Sexual HIV transmission can be dramatically reduced through artificial insemination and sperm washing; however, most couples cannot access these resources. We propose that periconception pre-exposure prophylaxis (PrEP) could offer an important, complementary therapy to harm reduction counseling programs that aim to decrease HIV transmission for couples who choose to conceive. In this paper, we describe the potential benefits of periconception PrEP and define critical points of clarification prior to implementation of PrEP as part of a reproductive health program. We consider sexual transmission risk, current risk reduction options, PrEP efficacy, cost, adherence, resistance, fetal toxicity, and impact of PrEP counseling on entry into health services. We address PrEP in the context of other periconception HIV-prevention strategies, including antiretroviral treatment of the HIV-infected partner. We conclude that, should PrEP prove safe and efficacious in ongoing trials, periconception PrEP may offer a useful approach to minimize risk of HIV transmission for individuals of reproductive age in HIV-endemic countries.
HIV 血清不一致的夫妇在满足生育愿望和冒着将 HIV 传播给伴侣和孩子的风险之间面临着复杂的选择。通过人工授精和精子洗涤可以显著降低性传播 HIV 的风险；然而，大多数夫妇无法获得这些资源。我们提出，围孕期暴露前预防（PrEP）可以为旨在减少选择怀孕的夫妇 HIV 传播的减少伤害咨询计划提供重要的补充治疗。在本文中，我们描述了围孕期 PrEP 的潜在益处，并在实施 PrEP 作为生殖健康计划的一部分之前，确定了需要澄清的关键点。我们考虑了性传播风险、当前的风险降低选择、PrEP 的疗效、成本、依从性、耐药性、胎儿毒性以及 PrEP 咨询对进入卫生服务的影响。我们在其他围孕期 HIV 预防策略的背景下讨论 PrEP，包括对 HIV 感染者伴侣的抗逆转录病毒治疗。我们的结论是，如果正在进行的试验证明 PrEP 安全有效，那么围孕期 PrEP 可能为 HIV 流行国家中具有生育能力的个人提供一种最小化 HIV 传播风险的有用方法。
