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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 and is recommended by the CDC , ACOG, and other national organizations. Purpose: Prevention of unintended pregnancies

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

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

  2. 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: • 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 www.aidsetc.org

  3. 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) www.aidsetc.org

  4. 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: • Efficacy • Hepatitis B status • Teratogenic potential • Possible adverse outcomes for mother and fetus(AII) www.aidsetc.org

  5. 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 HIV-infected men. HIV, and possibly ART, may be associated with a higher prevalence of abnormalities. www.aidsetc.org

  6. 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 CD4 counts ≤550 cells/µL and BIII for CD4 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. www.aidsetc.org

  7. 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) www.aidsetc.org

  8. Reproductive Options for HIV-Concordant and Serodiscordant Couples (4) • Periconception administration of PrEP for HIV-uninfected partners may offer an additional tool to reduce the risk of sexual transmission. (CIII) • The utility of PrEP 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. www.aidsetc.org

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