The case of a 28-year-old diagnosed with HIV when she became pregnant prompts Eileen and guest Dr. Jean Anderson to explore many of the challenges of HIV care in pregnancy: managing a new diagnosis, disclosure, stigma, partner involvement, antiretroviral therapy, perinatal transmission prevention, breastfeeding, harm reduction, and postpartum care. Their wide-ranging discussion opens with Jean’s perspective on care of women with HIV, which is informed by 40 years of ground-breaking work in the field.

References Cited:

• Connor EM, Sperling RS, Gelber R, et al. Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. Pediatric AIDS Clinical Trials Group Protocol 076 Study Group. N Engl J Med. 1994 Nov 3;331(18):1173-80. PMID: 7935654.
• Sibiude J, Le Chenadec J, Mandelbrot L, et al. Update of Perinatal Human Immunodeficiency Virus Type 1 Transmission in France: Zero Transmission for 5482 Mothers on Continuous Antiretroviral Therapy From Conception and With Undetectable Viral Load at Delivery. Clin Infect Dis. 2023 Feb 8;76(3):e590-e598. PMID: 36037040

Related Guidelines and Guidance:

• American College of Obstetricians & Gynecologists (ACOG): Optimizing Postpartum Care. Committee Opinion Number 736. May 2018.
• U.S. Department of Health and Human Services (DHHS): Recommendations for the Use of Antiretroviral Drugs During Pregnancy and Interventions to Reduce Perinatal HIV Transmission in the United States(June 2025)
• New York State Department of Health AIDS Institute Clinical Guidelines Program:
  - HIV Testing During Pregnancy, at Delivery, and Postpartum
  - NYS Good Practices to Prevent Perinatal HIV Transmission
  - Guidance: Questions, Answers, and Best Practices for Medical Management of Perinatal HIV Exposure in New York State
  - U=U Guidance for Implementation in Clinical Settings
  - PrEP to Prevent HIV and Promote Sexual Health

Resources:

• Antiretroviral Pregnancy Registry
• CDC HIV Hotlines and Warmlines > Perinatal HIV Hotline: Provides clinicians with around-the-clock advice on indications and interpretations of HIV testing in pregnancy, and consultation on antiretroviral use during pregnancy, labor and delivery, and the postpartum period. 1-888-448-8765 (24 hours, seven days a week)
• Edinburgh Postnatal Depression Scale

Like many in HIV, Chris is also a PrEP provider. In this episode, he presents a case to Dr. Rona Vail to work through the best approach to PrEP for a young, gay Black man. They work through the issues of oral vs injectable PrEP, dosing schedules for oral PrEP, the studies that support each approach, and this patient’s eligibility for each to determine the best recommendations. They end by discussing barriers to PrEP and the importance of choices now that there are so many PrEP options.

References Cited:

• Bekker LG, Das M, Abdool Karim Q, et al. Twice-Yearly Lenacapavir or Daily F/TAF for HIV Prevention in Cisgender Women. N Engl J Med. 2024 Oct 3;391(13):1179-1192. PMID: 39046157.
• Grant RM, Lama JR, Anderson PL, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010 Dec 30;363(27):2587-99. PMID: 21091279.
• Kiweewa FM, Ahmed K, Nair G., et al. Adherence to F/TAF in cisgender women prevents HIV with low risk of resistance or diagnostic delay. Abstract 194. CROI; 2025 Mar 9-12; San Francisco, CA. https://www.croiconference.org/abstract/1937-2025/.
• Koss CA, Ayieko J, Kabami J, et al. Dynamic choice HIV prevention intervention at outpatient departments in rural Kenya and Uganda. AIDS. 2024 Mar 1;38(3):339-349. PMID: 37861683.
• Marrazzo J, Tao L, Becker M, et al. HIV Preexposure Prophylaxis With Emtricitabine and Tenofovir Disoproxil Fumarate Among Cisgender Women. JAMA. 2024 Mar 19;331(11):930-937. PMID: 38427359.
• Mayer KH, Molina JM, Thompson MA, et al. Emtricitabine and tenofovir alafenamide vs emtricitabine and tenofovir disoproxil fumarate for HIV pre-exposure prophylaxis (DISCOVER): primary results from a randomised, double-blind, multicentre, active-controlled, phase 3, non-inferiority trial. Lancet. 2020 Jul 25;396(10246):239-254. PMID: 32711800.
• Molina JM, Ghosn J, Assoumou L, et al. Daily and on-demand HIV pre-exposure prophylaxis with emtricitabine and tenofovir disoproxil (ANRS PREVENIR): a prospective observational cohort study. Lancet HIV. 2022 Aug;9(8):e554-e562. PMID: 35772417.
• Molina JM, Capitant C, Spire B, et al. On-Demand Preexposure Prophylaxis in Men at High Risk for HIV-1 Infection. N Engl J Med. 2015 Dec 3;373(23):2237-46. PMID: 26624850.

Related NYSDOH AIDS Institute Clinical Guidelines and Guidance:

• PrEP to Prevent HIV and Promote Sexual Health
• PEP to Prevent HIV Infection
• Guidance: Adopting a Patient-Centered Approach to Sexual Health
• GOALS Framework for Sexual History Taking in Primary Care
• Prevention and Management of Hepatitis B Virus Infection in Adults With HIV

Hello Viremic listeners. We are taking a break this week and encourage you to take a look back at our past episodes and catch up on any cases you may have missed. We'll be back on January 6, 2026 with a new case to discuss!

From all of us at Viremic we hope you have a peaceful, healthy and joyous holiday season!