A report back on Deb Bateson, Moira Wilson, Rachael Dunn and Diane Lloyd's presentation HIV&AIDS symposium 19, HIV and women across the reproductive lifespan and beyond

Wednesday afternoon saw the first session specifically for women living with HIV. The small meeting room was overflowing with every seat taken with not even standing room left. Diane Lloyd spoke of women’s invisibility during her 33 years of living with HIV in Australia and her point wasn’t lost on the audience. Deborah Bateson opened the session with a discussion of contraception choices for women living with HIV. While all methods are potentially suitable, interactions with enzyme inducing ARVs can cause issues with oral contraceptive pills and may lead to increased method failure. This can also cause a problem with levonorgestrel emergency contraception requiring a double dose. There was eager anticipation of the results of the ECHO trial from South Africa released in June this year which didn’t find any increase in HIV acquisition for women with the use of injectable progesterone contracepton despite years of concern.   

Moira Wilson then had an almost insurmountable task of taking us through the latest evidence around ARV use in pregnancy. Many people were aware of the signal seen in the Tsepamo study in Botswana with Dolutegravir and neural tube defects. Results of an expansion of the study were presented at IAS this year and while the risk appears to be much lower than first thought, the signal still remains. Dolutegravir is otherwise an excellent choice for use in pregnancy however should be avoided in the first 8 weeks, and hence, avoided in women of childbearing potential who are not using a reliable method of contraception. With second generation integrase inhibitors and tenofovir alafenamide (TAF) being widely used it is crucial that we have more data on their use in pregnancy.  Elvitegravir/cobicistat and TAF are having minimal transplacental activity. How important transplacental ARV exposure is remains unclear but it may be having a PrEP effect for the baby. 

Rachael Dunn then took us through the recommendations that will likely become the ASHM guidelines for breastfeeding. There is a distinct lack of data in resource rich settings to inform the new guidelines and it is expected that Australia will follow the British and US guidelines and continue to recommend formula feeding to prevent mother to child transmission, but provide support to women who choose to breastfeed after extensive counselling and in conjunction with a number of (quite arduous) harm minimisation strategies. The guidelines were welcomed by the audience, but robust discussion during question time reinforced how relevant these sessions are.
 

Author bio: Sharon is the Clinical Nurse Consultant for HIV & Sexual Health at St George Hospital, Sydney, NSW.