Seidman, D.L., Weber, S., Cohan, D. Journal of the International AIDS Society (March 2017), 20 (Suppl 1): 24–30, doi:10.7448/IAS.20.2.21295.
Studies suggest that HIV acquisition during the perinatal period significantly increases the risk of vertical transmission. Thus, this period offers important opportunities for HIV prevention or treatment services. The authors of this commentary reviewed the safety of oral pre-exposure prophylaxis (PrEP) with tenofovir/emtricitabine in pregnant and lactating women. They described a "shared decisionmaking" clinical approach for identifying high-risk women and addressing their risk during pregnancy, including using (or not using) PrEP during periods of higher vulnerability. Evidence suggests that PrEP with tenofovir/emtricitabine is safe during pregnancy and lactation. However, numerous factors make it difficult to identify high-risk women who could be candidates for PrEP. The shared decision making approach uses provider–client interaction to identify vulnerability. In this approach, implemented at set intervals during the perinatal period, the client is tested for HIV and sexually transmitted infections, and the provider and client assess her vulnerability and decide together the best options for HIV prevention, including PrEP, for periods of high vulnerability. This approach, the authors said, would facilitate the difficult task of identifying women at high risk of HIV, but would need to be tested in diverse clinical settings. They added that future prevention research must include pregnant and breastfeeding women to strengthen development of evidence-informed public health policies and clinical guidelines.