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There are now multiple options for serodiscordant couples who want to conceive while minimizing the risk of transmitting HIV to their uninfected partner. The CDC states that individuals with HIV who are adherent to ART and with a sustained, undetectable viral load have essentially no risk of transmitting HIV through sex. The data from HPTN-052 showing a greatly reduced risk of HIV transmission from HIV-infected partners with undetectable HIV-1 RNA during ART, combined with the data from the Partners PrEP study showing reduced risk of HIV acquisition in individuals taking daily oral emtricitabine/tenofovir DF, have increased the options for HIV serodiscordant couples planning a pregnancy. It is important to note that genetically linked HIV transmissions did not occur while the partner with HIV was virologically suppressed. If ART is initiated in the partner with HIV, the DHHS guidelines panel recommends that maximal virologic suppression is attained before attempting conception. Administering oral PrEP to the partner without HIV is recommended if viral suppression in the partner with HIV has not been achieved or if their viral suppression status is unknown. Data from a modeling study that examined the usefulness of PrEP when condomless sex acts occurred only during the ovulation period or when sex acts were not limited to ovulation, showed that PrEP provided little added benefit when the male partner was on ART and had a suppressed viral load and when the couple limited sex without a condom to the ovulation period and improved other modifiable transmission risks. The panel recommends that education about the potential risks and benefits and all available alternatives for safer conception be provided when prescribing PrEP to serodiscordant couples. CDC guidelines recommend that a woman without HIV who is planning a pregnancy with a partner who has HIV infection start daily oral emtricitabine/tenofovir DF 1 month before trying to conceive and continuing for 1 month after conception occurs. If the couple is going to continue having condomless sex after conception and the partner with HIV has not achieved sustained viral suppression, the partner without HIV should continue to take PrEP to decrease the risk of secondary transmission.
The DHHS recommendations for serodiscordant couples who want to conceive include the following ART interventions:
Other, non-ARV interventions are also available. The DHHS recommendations include the following: