PREEXPOSURE PROPHYLAXIS in Pregnancy in South Africa Dr Francesca Conradie President of the Southern African HIV Clinician Society Guideline process in South Africa Southern African HIV Clinicians Society ID: 768758
Download Presentation The PPT/PDF document "PRE-EXPOSURE PROPHYLAXIS in Pregnancy ..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
PRE-EXPOSURE PROPHYLAXIS in Pregnancy in South Africa Dr. Francesca Conradie President of the Southern African HIV Clinician Society
Guideline process in South Africa Southern African HIV Clinicians Society develop guidelines using the best evidence at the time for treatment and prevention in adults, children as well as some “niche” guidelines. National Department of Health develop guidelines for the public sector for the treatment of all who live South Africans
Southern African HIV Clinician statement Women who become pregnant or breastfeed on pre-exposure prophylaxis HIV-negative women in serodiscordant relationships Pregnancy is associated with an increased risk of seroconversion The use of PrEP around the time of conception and during pregnancy offers a means of protection to the uninfected partner. Data relating to the safety on the developing fetus limited Clinician should discuss potential risks and benefits of PrEP initiation or maintenance
National Department of Health In South Africa, the currently approved form of TDF/FTC, Truvada, is contra-indicated for use as PrEP in pregnant or breastfeeding women for PrEP
Risk benefit ratio Tolerance of adverse events is higher in treatment of conditions with poor outcomes e.g. XDR TBTolerance of adverse events is low in preventative treatment e.g. hepatotoxicity of INHTolerance of adverse events is low in treatment in pregnancyTolerance of adverse events is very low in preventative treatment in pregnancy
TDF in pregnancy TDF/FTC is a category B drugWidely used in treatmentBenefit of suppressive therapy in an HIV infected pregnant woman is without question
What evidence do we have the PrEP is not associated with adverse pregnancy outcomes? NoneIn PrEP trials women were taken off medication as soon as pregnancy was detected. During these trials, no health problems have been associated with PrEP use by women in early pregnancy or for their offspring. However, the long-term safety of PrEP taken HIV-uninfected women after fetal (during pregnancy) or infant (during breastfeeding) exposure is not yet determined.
Conclusion Two guideline processes have come to different conclusionsAs evidence is collected, these may change
Acknowledgment Southern African HIV Clinicians Society Writing team for the Society Dr Michelle MoorhouseLauren Jankelowitz National Department of Health Yogan Pillay Zuki Panini