在接受抗逆转录病毒治疗（ART）且病毒载量得到抑制的 HIV-1 血清学不一致夫妇中，自然受孕期间是否需要 PrEP？一项回顾性队列分析。
Is PrEP necessary during natural conception in HIV-1-serodiscordant couples on ART with suppressed viral load? A retrospective cohort analysis.
机构信息
Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China.
Department of Infectious Diseases, Shenzhen Third People's Hospital, Shenzhen, 518112, China.
出版信息
BMC Infect Dis. 2020 Mar 6;20(1):195. doi: 10.1186/s12879-020-4912-4.
BACKGROUND
Antiretroviral therapy (ART) demonstrates high efficacy in reducing the risk of HIV transmission to sexual partners. However, it is not clear if the use of pre-exposure prophylaxis (PrEP) in HIV-1-serodiscordant couples is necessary during natural conception when the HIV-positive partner exhibits a suppressed viral load. The purpose of this study was to assess the role of PrEP during natural conception in this population.
METHODS
A retrospective, multicenter study was conducted in a cohort of HIV-1-serodiscordant couples (positive man, negative woman) with childbearing desires. HIV-positive male partners were treated with ART and achieved viral suppression for more than half a year. The HIV-negative female partners were either treated with PrEP or not treated with PrEP, and outcomes were compared between the two treatment groups.
RESULTS
Of 246 HIV-1-serodiscordant couples in whom the HIV-positive partner achieved viral suppression, 104 seronegative women were treated with PrEP during natural conception and 142 seronegative women were not treated with PrEP. There were 410 condom-less sexual acts in couples treated with PrEP and 615 condom-less sexual acts in couples not treated with PrEP. We observed no instances of HIV transmission in HIV-1-serodiscordant couples with or without the use of PrEP during the process of natural conception.
CONCLUSIONS
Our results show that PrEP had minimal influence in reducing the risk of HIV transmission during natural conception in HIV-1-serodiscordant couples with a stably suppressed viral load. Thus, it may be an acceptable option for HIV-negative partners to not use PrEP during the process of natural conception if the HIV-positive partner has achieved viral suppression for more than half a year.
背景
抗逆转录病毒疗法（ART）在降低 HIV 经性传播给性伴侣的风险方面具有很高的疗效。然而，当 HIV 阳性伴侣的病毒载量受到抑制时，在 HIV-1 血清不一致的夫妇中进行自然受孕期间是否需要使用暴露前预防（PrEP）尚不清楚。本研究的目的是评估在这种人群中 PrEP 在自然受孕期间的作用。
方法
对有生育愿望的 HIV-1 血清不一致夫妇（阳性男性，阴性女性）队列进行回顾性、多中心研究。HIV 阳性男性伴侣接受 ART 治疗，病毒抑制超过半年。阴性女性伴侣要么接受 PrEP 治疗，要么不接受 PrEP 治疗，比较两组的治疗结果。
结果
在 246 对 HIV-1 血清不一致且 HIV 阳性伴侣病毒抑制的夫妇中，104 名阴性女性在自然受孕期间接受 PrEP 治疗，142 名阴性女性未接受 PrEP 治疗。在接受 PrEP 治疗的夫妇中有 410 次无保护性行为，在未接受 PrEP 治疗的夫妇中有 615 次无保护性行为。我们在使用或不使用 PrEP 的 HIV-1 血清不一致的夫妇中自然受孕过程中没有观察到 HIV 传播的情况。
结论
我们的研究结果表明，在 HIV-1 血清不一致的夫妇中，病毒载量稳定抑制超过半年的情况下，PrEP 对降低自然受孕过程中 HIV 传播的风险影响很小。因此，如果 HIV 阳性伴侣的病毒载量受到抑制超过半年，对于阴性伴侣来说，在自然受孕过程中不使用 PrEP 可能是一种可以接受的选择。
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