Take Control of Your Sexual Health | Women’s Health (PrEP to Protect You and Your Baby) | Why PrEP? | More About PrEP Meds | What to Expect at Your Visit | Downloadable Infographics

This information was prepared for you by

Jonathan Shuter, MD, a Professor of Medicine in the Division of Infectious Diseases at Montefiore Medical Center and the Albert Einstein College of Medicine

Uriel Felsen, MD, an Associate Professor of Medicine in the Division of Infectious Diseases at Montefiore Medical Center and the Albert Einstein College of Medicine

Raffaele M. Bernardo, DO, an Assistant Professor of Medicine in the Division of Infectious Diseases at Montefiore Medical Center and the Albert Einstein College of Medicine.

SUMMARY:

If you are thinking about getting pregnant, are pregnant, or have a baby, you are probably thinking a lot about both your health and the health of the baby. If you are trying to get pregnant and your partner is living with HIV, it is VERY important that you speak to your health care team about ways to lower the chance of HIV transmission. The group of infections that can be passed through sex have been called many different names: venereal diseases or VDs, sexually transmitted diseases or STDs, and sexually transmitted infections or STIs. On this site, we will call them STDs. In addition to HIV, other STDs, like herpes and syphilis, can also be dangerous for the baby. It is important that you speak with your health care team about controlling your risk for STDs and treating any you may have before, during, and after your pregnancy

What is PrEP?

• PrEP stands for Pre-Exposure Prophylaxis
  • “Pre-exposure” means having medicine in your system even before you have sex
  • “Prophylaxis” means the medicine prevents you from getting HIV even if your partner has it

What’s Changed?

• Until 2012
  • The only ways to avoid getting HIV from sex were
    • To not have sex
    • Never have sex with someone with HIV
    • Use condoms properly every single time
  • And still … way too many people still got HIV from sex
• Today, there are more ways to reduce your risk of HIV
  • Newer medications for people with HIV that really work
    • If your partner has HIV, make sure your partner takes HIV meds and has an undetectable HIV viral load | “Undetectable” means that the HIV virus cannot be found in the person’s blood
    • Someone who STAYS undetectable by taking meds the right way can’t give anyone else the virus through sex
  • Take PrEP to protect yourself if you don’t have HIV

More on PrEP

• When PrEP medicine is taken correctly it provides safe and excellent protection against HIV
• IF YOU DON’T TAKE IT, IT CAN’T WORK
• In most states, you cannot get PrEP without a physician prescription | In certain states, pharmacists may provide PrEP to people without a doctor’s prescription

What You Need to Know About PrEP Medications During Pregnancy

TDF/FTC (pills)

• TDF/FTC is one pill that contains 2 medicines and is also known as
  • Truvada
  • Tenofovir disoproxil fumarate/emtricitabine
• Takes about a week to build up to protective levels in your system, except in the vagina where it can take three weeks
• TDF has been used as a medicine for HIV since 2001 and FTC since 2004
  • These meds have been around for a long time
• Use of TDF/FTC in pregnancy
  • Many pregnant women have used TDF/FTC, both women living with HIV and women on PrEP
  • It is considered safe for both mom and baby
  • Less is known about TDF/FTC if you’re breastfeeding (more below)

Cabotegravir (injection)

• Cabotegravir injection is also known as
  • Apretude
  • CAB-LA
• Has been used in the US as a medicine for HIV since January 2021
• Cabotegravir use in pregnancy
  • Has been used by very few pregnant and breastfeeding women
  • There is no sign yet of any significant risk, but it is too early to say anything about its safety with confidence

Note: TAF/FTC is another combination pill that is effective at preventing HIV but has not been approved as a PrEP medication for vaginal sex, so TDF/FTC and cabotegravir are the only medicines for use in people who are or are trying to get pregnant

If You are Already on PrEP Medication During the Time You are Trying to Get Pregnant

TDF/FTC

• Continue it unless you, together with your health care team, decide that the chance of HIV transmission from your partner(s) is extremely low, such as
  • If you stop having sex during pregnancy
  • If your partner is HIV negative (and both you and your partner have no other partners)
  • If your partner is living with HIV, takes meds consistently and correctly, and has kept an undetectable viral load

Note: Remember that it will take up to three weeks to be safely back on PrEP again if you decide to restart it

Cabotegravir

• Discuss with your health care team whether to
  • Continue
  • Stop
  • Switch to TDF/FTC

Breastfeeding

• TDF/FTC
  • Appears to be safe for mom and baby if you are breastfeeding
  • However, there is not enough experience to know for sure
• Cabotegravir
  • Almost nothing is known about cabotegravir and breastfeeding since this is a newer medication

Note: If you are thinking about taking PrEP and breastfeeding, you should discuss this with your health care team, including your baby’s pediatrician

Learn More – Primary Sources

There are many good websites with information people interested in learning more about PrEP. Here are a few:

CDC: PrEP Is for Women (cdc.gov)

CDC: PrEP (Pre-exposure Prophylaxis)

NIH: Pre-Exposure Prophylaxis

International Association of Providers of AIDS Care (iapac.org): Pre-Exposure Prophylaxis (PrEP)

New York State Department of Health

PleasePrEPMe (California State)

Commercial Support

This educational activity is supported by an independent educational grant from Gilead Sciences

Faculty Disclosures

Dr. Shuter has no relevant financial relationships to disclose

Dr. Felsen has no relevant financial relationships to disclose

Dr. Bernardo has no relevant financial relationships to disclose

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