Antiretrovirals for safer conception for HIV-negative women and their HIV-1-infected male partners: how safe and how available?

We have entered a new era in which antiretroviral agents have been demonstrated to be highly effective in preventing HIV-1 infection, especially in serodiscordant couples. The HPTN-052 randomized, controlled trial (RCT) of early versus delayed antiretroviral therapy (ART) for the HIV-1-infected persons in sexual partnerships with HIV-negative persons demonstrated at least a 96% reduction in HIV-1 transmission in the 1763 couples studied in Africa, Asia and South America [1]. The Partners PrEP RCT, conducted among 4758 HIV-1serodiscordant couples in Kenya and Uganda, showed that when used as preexposure prophylaxis (PrEP) by the HIV-negative partner, daily tenofovir disproxil fumerate (TDF) and daily TDF/emtricitabine (FTC) were 62 and 73% effective, respectively, in preventing HIV-1 acquisition [2]. These robust effectiveness findings provide a strong basis for the use of antiretroviral agents for prevention, both to reduce the infectiousness of HIV-1infected persons and to reduce the susceptibility of HIVnegative persons.