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PrEP to have a baby

Apr 7, 2012

Hello Doc,

I'm a + man and my wife -

I was diagnosed positive 2 weeks after my wife gave birth. Luckily she had never been infected with the virus. and our baby also negative.

I'm on Truvada + Isentress and doing quite well until now (CD4 440/20%, VL <40)

We plan to have a baby and my wife doesn't want to do artificial insemination and sperm washing method.

I want to ask you , is it safe for my wife just to take Truvada as a PrEP and unprotected sex until we get the baby?

I mean,in our case ,even when my viral load was about 500K before and we did unprotected sex ( yes, because we didn't know that i'm +) still I did not pass the virus to her and she gave birth without any issue

Secondly, my dosing time is not always in time, with variation between 1-3 hours late or early, but I've never missed a dose until now. Is it still ok?

Thank You...

Response from Dr. Young

Hello and thanks for posting.

Your questions raise a number of interesting points.

First off, it's terrific that you're on medications with a normal CD4 and undetectable HIV viral load. There's no problem in my opinion with the time variation of your dosing, indeed, your undetectable viral load is proof of this point.

With regard to pregnancy and transmission risk, your undetectable viral load is probably the single greatest factor in reducing risk of HIV transmission to your wife. Some might even conclude that this alone is sufficient to reduce risk; however, one should be mindful that I have difficulty making proclamations about HIV risk or blanket statements about safety- it's a decision that needs to be made carefully among partners and healthcare providers.

With that said, I have counseled couples in your situation and have recommended further risk reduction with pre- and post-exposure prophylaxis to the woman (appreciating that there's little data to formally support this). I've worked with pregnancy experts to try to minimize the amount of exposure, namely to try to limit sexual intercourse (and therefore, HIV risk) around the time of ovulation (and likelihood of getting pregnant). We've used tenofovir/FTC (Truvada) in this situation and treat for about 1 month after the last sexual exposure. All of this should be done in a medically monitored setting and screening for HIV, hepatitis and baseline risk of kidney injury.

Happily, we've helped couples conceive healthy babies this way without HIV transmission.

I hope that's helpful.

Be well, BY

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