Pre-exposure prophylaxis in sero-discordant male partners of human immune deficiency virus (HIV) positive women desirous of natural conception - a clinical setting experience

Abstract

The reproductive health needs of sero-discordant couples are issues of concerns, especially in view of high cost of various assisted conception methods in the low-resource economies. Often times, many of these couples resort to un-informed and unsafe practices of unprotected heterosexual intercourse, leading to human immune deficiency virus (HIV) acquisition. The magnitude of the health burden of these populations in Nigeria and other developing economies are currently not fully determined. Pre-exposure prophylaxis (PrEP) in conjunction with other HIV prevention strategies provides the only veritable and possibly safe mean of achieving their reproductive desire. This is a cohort study of 42 HIV-1 sero-discordant male partners of known HIV-1 positive women who were desirous of conception. All the male participants recruited were aware of their female partners’ status, had their HIV status determined by fourth generation enzyme linked immunosorbent assay kit and were HIV negative, but declined the offer of assisted conception. The HIV positive women were all on highly active antiretroviral therapy (HAART). Thirty sero-discordant partners were sequentially and equally randomised into the two treatment groups [TDF and daily tenofovi/emtricitabine (TDF-FTC)], while 12 participants who declined PrEp made up the control group. In resource constraint settings, where assisted conception methods are either unacceptable, declined or un-affordable to male sero-discordant couples in heterosexual relationships, pre-exposure prophylaxis, preferably oral daily tenofovir-emtricitabine combination may be considered in addition to other HIV prevention strategies and timed sexual exposure, towards achieving safe reproductive health needs. Key words: Human immune deficiency virus (HIV), pre-exposure prophylaxis, sero-discordant heterosexual partners, reproductive desire.