Pregnant and postpartum women more susceptible to HIV infection

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HIV-1 is the leading cause of death for women of reproductive age around the world. In sub-Saharan African countries facing a higher incidence of HIV, fertility rates are also high and women spend much of their reproductive years pregnant or breastfeeding. New research from University of Washington, Kenya Medical Research Institute and Craig Cohen at UCSF provides strong evidence that women are at greater risk of HIV-1 infection during late pregnancy and post-partum.

The study looked at data from couples from 7 African countries in which the male partner had HIV and the female partner did not. The research team found that the likelihood of acquiring HIV-1 from a sex act without a condom was 3 times as high in late pregnancy and 4 times as high post-partum compared to times when a woman was not pregnant.

The findings suggest that biological changes during and just after pregnancy increase susceptibility to HIV infection. The risk was high even after adjusting for other factors that make HIV-1 transmission more likely.

This study highlights the need for enhanced HIV prevention and testing strategies during and after pregnancy. Pre-exposure prophylaxis (PrEP) can play an important role, especially for women who are unable to engage male partners in HIV prevention. There are innovative approaches such as home-based couples testing or treating women with vaginal probiotics (currently under study by Bixby scientists) to normalize the vaginal microbiome that may also reduce HIV infection among women. It is crucial to continue counseling on risk and options for women during this period of increased vulnerability to HIV-1 infection.