1. PRE-EXPOSURE PROPHYLAXIS in Pregnancy in South Africa
Dr. Francesca Conradie
President of the Southern African HIV Clinician Society

3. Guideline process in South Africa
Southern African HIV Clinicians Society develop guidelines using the best evidence at the time for treatment and prevention in adults, children as well as some “niche” guidelines.
National Department of Health develop guidelines for the public sector for the treatment of all who live South Africans

4. Southern African HIV Clinician statement
Women who become pregnant or breastfeed on pre-exposure prophylaxis
HIV-negative women in serodiscordant relationships
Pregnancy is associated with an increased risk of seroconversion
The use of PrEP around the time of conception and during pregnancy offers a means of protection to the uninfected partner.
Data relating to the safety on the developing fetus limited
Clinician should discuss potential risks and benefits of PrEP initiation or maintenance

5. National Department of Health
In South Africa, the currently approved form of TDF/FTC, Truvada, is contra-indicated for use as PrEP in pregnant or breastfeeding women for PrEP

6. Risk benefit ratio
Tolerance of adverse events is higher in treatment of conditions with poor outcomes e.g. XDR TB
Tolerance of adverse events is low in preventative treatment e.g. hepatotoxicity of INH
Tolerance of adverse events is low in treatment in pregnancy
Tolerance of adverse events is very low in preventative treatment in pregnancy

7. TDF in pregnancy TDF/FTC is a category B drug Widely used in treatment
Benefit of suppressive therapy in an HIV infected pregnant woman is without question

8. What evidence do we have the PrEP is not associated with adverse pregnancy outcomes?
None
In PrEP trials women were taken off medication as soon as pregnancy was detected.
During these trials, no health problems have been associated with PrEP use by women in early pregnancy or for their offspring.
However, the long-term safety of PrEP taken HIV-uninfected women after fetal (during pregnancy) or infant (during breastfeeding) exposure is not yet determined.

9. Conclusion Two guideline processes have come to different conclusions
As evidence is collected, these may change

10. Acknowledgment Southern African HIV Clinicians Society
Writing team for the Society
Dr Michelle Moorhouse
Lauren Jankelowitz
National Department of Health
Yogan Pillay
Zuki Panini