The combined use of pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART) can help HIV discordant couples have safe pregnancies, a new research shows.
In a study carried out on 74 couples by a team of local and international scientists, 40 women got pregnant, some more than once, without a single case of HIV transmission.
Seven of the women got pregnant twice, bringing the total pregnancies reported in the group under investigation to 47.
PrEP is a course of HIV medicine taken by those without the virus to reduce the risk of infection.
Truvada is the main drug approved for use as PrEP.
It is a single pill that combines two drugs — tenofovir and emtricitabine.
Another tenofovir-based drug is to be approved soon.
ART consists of the combination of antiretroviral (ARV) drugs to significantly suppress the virus and stop the advance of Aids in people with the virus.
ART also prevents onward transmission of HIV from such individuals to those without the virus.
Kenneth Ngure, an associate professor and research coordinator at Jomo Kenyatta University of Agriculture and Technology’s College of Health Sciences and the chairman of Department of Community Health, Kenya, said the study has proved to be an important step in providing safe alternatives to HIV discordant couples who desire to have children.
Prof Ngure, who is also an affiliate associate professor at the Department of Global Health, University of Washington, the United States, said the results of the report are likely to be published next month.
It is estimated that there are close to 200,000 HIV discordant couples in Kenya.
“During our study, we discovered that many HIV negative women and men in discordant relationships are willing to conceive naturally, even if it carries the possibility of getting infected with HIV,” Prof Ngure said.
The researcher attributed the phenomenon to the desire for women to conceive, in addition to pressure from families, relatives and the society to get children once one is married.
“Due to the African culture’s emphasis on the importance of children, many women in discordant relationships are driven by a strong desire to conceive naturally. It could be pressure from in-laws, family members and the wider society,” he said.
The researcher added that most couples in the study were not comfortable with artificial insemination due to a variety of reasons, including cost and the misconception that the these methods could result in deformed or abnormal children.
“Their fears are unfounded as these are tried and tested methods that result in the delivery of healthy babies,” he said.
“We also observed that most couples prefer to use a combination of PrEP, ART and timed condom-less sex during the period they are fertile.”
Prof Ngure said the team put the study participants on a regime of ART and PrEP during the period of the study.
Among the 74 couples, forty pregnancies were reported, with no resulting cases of HIV transmission.
“None of the HIV negative women and men in the couples that conceived reported infection,” the professor said.
According to a 2018 report from PrEP Watch, there are 26,000 estimated users of PrEP in Kenya, against a target of 37,000 from ongoing and planned projects.
Globally, there are 309,525 people on the drug in 68 countries.
Seven out of 10, or 71 per cent of the users, are in North America.
In Sub-Sahara, around 49,000 people, mostly adolescent girls and young women, are on PrEP, against a target of 141,754.
Most PrEP users in Africa are in Kenya, South Africa, Uganda, Zimbabwe and Lesotho.
The professor said there is a huge need for conception among discordant couples to be made safer in order to reduce the risk of HIV transmission.
“If a conservative estimate of 80 per cent of the 200,000 couples wishes to conceive, that would translate to 160,000 couples which means that there is a need to make the process safe,” he said.
“The study findings have shown that a safer conception intervention that utilises a combination of PrEP and ART and timed conception is the most preferred option and needs to be urgently scaled up for the thousands of Kenyan HIV discordant couples.”