PRECONCEPTION COUNSELING AND CARE FOR HIVINFECTED WOMEN OF

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PRECONCEPTION COUNSELING AND CARE FOR HIV-INFECTED WOMEN OF CHILDBEARING AGE

PRECONCEPTION COUNSELING AND CARE FOR HIV-INFECTED WOMEN OF CHILDBEARING AGE

Preconception Counseling and Care (1) § Preconception care is part of routine primary care

Preconception Counseling and Care (1) § Preconception care is part of routine primary care and is recommended by the CDC, ACOG, and other national organizations. § Purpose: § § 2 Prevention of unintended pregnancies Optimization of maternal health prior to pregnancy Prevention of perinatal transmission Prevention of HIV transmission to an uninfected partner while trying to conceive August 2012 www. aidsetc. org

Preconception Counseling and Care (2) Recommendations § Discuss childbearing intentions with all women of

Preconception Counseling and Care (2) Recommendations § Discuss childbearing intentions with all women of childbearing age on an ongoing basis throughout the course of their care. (AIII) § Include information about effective and appropriate contraceptive methods. (AI) § Preconception counseling: Include information on safer sex and elimination of alcohol, illicit drugs, and smoking. (AII) 3 August 2012 www. aidsetc. org

Preconception Counseling and Care (3) § Include assessment of HIV disease status and need

Preconception Counseling and Care (3) § Include assessment of HIV disease status and need for ART for the health of the woman. (AII) § Choose an ART regimen for HIV-infected women of childbearing age based on: § § 4 Efficacy Hepatitis B status Teratogenic potential Possible adverse outcomes for mother and fetus (AII) August 2012 www. aidsetc. org

Reproductive Options for HIV-Concordant and Serodiscordant Couples (1) All couples: § Both partners should

Reproductive Options for HIV-Concordant and Serodiscordant Couples (1) All couples: § Both partners should be screened for genital tract infections. (AII) § Semen analysis is recommended for HIVinfected men. HIV, and possibly ART, may be associated with a higher prevalence of abnormalities. 5 August 2012 www. aidsetc. org

Reproductive Options for HIV-Concordant and Serodiscordant Couples (2) Serodiscordant couples: § Expert consultation is

Reproductive Options for HIV-Concordant and Serodiscordant Couples (2) Serodiscordant couples: § Expert consultation is recommended. (AIII) § No single method of safer conception is fully protective against transmission of HIV. § Initiation of ART for the HIV-infected partner is recommended (AI for CD 4 counts ≤ 550 cells/µL and BIII for CD 4 counts >550 cells/µL). § Maximal viral suppression is recommended before attempting conception. (AIII) § HPTN 052 trial showed ART can significantly decrease HIV transmission to uninfected partners. 6 August 2012 www. aidsetc. org

Reproductive Options for HIV-Concordant and Serodiscordant Couples (3) § HIV-infected female with uninfected male

Reproductive Options for HIV-Concordant and Serodiscordant Couples (3) § HIV-infected female with uninfected male partner: The safest option is artificial insemination, including the option of self-insemination, during the periovulatory period. (AIII) § HIV-infected man with uninfected female: Sperm preparation techniques + either intrauterine insemination or in vitro fertilization should be considered if using donor sperm from an uninfected male is unacceptable. (AII) 7 August 2012 www. aidsetc. org

Reproductive Options for HIV-Concordant and Serodiscordant Couples (4) § Periconception administration of Pr. EP

Reproductive Options for HIV-Concordant and Serodiscordant Couples (4) § Periconception administration of Pr. EP for HIVuninfected partners may offer an additional tool to reduce the risk of sexual transmission. (CIII) § The utility of Pr. EP of the uninfected partner when the infected partner is receiving ART has not been studied. § Outcome studies are needed to examine adverse events, including risk of congenital abnormalities. 8 August 2012 www. aidsetc. org