In the short time since publication of the review of Lampe et al of preexposure prophylaxis (PrEP) and other safer conception options for human immunodeficiency virus (HIV)-serodiscordant couples, results from 2 important studies have been released. These studies are significant additions to the landscape of safer conception options.

The FEM-PrEP trial ( NCT00625404 ; www.clinicaltrials.gov ), a randomized trial to evaluate the efficacy of Truvada (Gilead, Foster City, CA) among high-risk, HIV-uninfected women, was prematurely stopped. Of the 1951 women enrolled, 56 women experienced incident HIV infection–an equal number of women in the Truvada and placebo arms. In addition, 9% of study participants became pregnant despite universal provision of contraception, and pregnancy rates were significantly higher among those simultaneously receiving oral contraceptive pills and Truvada. The lack of efficacy in preventing sexual HIV acquisition was highly unexpected, particularly given that CAPRISA and iPrEx demonstrated high levels of efficacy of tenofovir vaginal gel and oral Truvada PrEP in preventing incident HIV among high-risk women and men who have sex with men, respectively. Given the apparent discrepancy in results among these tenofovir trials, secondary analyses, including rigorous evaluation of adherence and drug levels among FEM-PrEP participants, are ongoing. Importantly, HPTN 052, a randomized controlled trial of immediate vs delayed initiation of antiretroviral therapy among HIV-infected adults with CD4 counts >350 who were in serodiscordant relationships ( NCT00074581 ), was halted 4 years early by an independent data and safety monitoring board after demonstrating a 96% reduction in sexual transmission among couples randomized to immediate antiretroviral initiation.

Now, 30 years since the first reported case of AIDS, preventing HIV transmission remains challenging, but clinicians have an array of options to offer serodiscordant couples seeking conception. Mounting evidence exists that effective antiretroviral therapy can be a powerful prevention measure. Pending final analyses, PrEP still might be offered on a case-by-case basis, but only with excellent adherence and follow-up. The Health Resources and Services Administration–funded National Perinatal HIV Hotline and Clinicians Network (888-448-8765) is a free 24/7 resource for clinicians with a wide range of questions and consultation needs, including assistance in managing serodiscordant couples seeking conception. From August 2006 through January 2010, the hotline received 94 such calls; 90% of serodiscordant-related calls involved HIV-positive male/HIV-negative female couples; 77% requested referral to clinics offering assisted reproductive services; and 20% inquired about lower cost options including periconceptional PrEP. Multiple options for serodiscordant couples trying to conceive are now available and with proper individualization can be implemented safely.