Four wives became subsequently infected after several years with their Husband been Positive for 9 years ,They all want children and cannot afford IVF in developing country where they reside,they were all faithful to HIM ,unfortunately despite husbands Retro-viral medications ,they all are positive subsequently 2,4,6,9 years later respectively ,this circle of infection can it be stopped by Prophylaxis before ,during and after intercourse?.
If you ask about PrEP, I think it could work of course (evidences show that) but in my opinion far more important is to reach undetectable viral load using antiretroviral drugs in husband.
But I'm not sure if I understood your question correctly - if all of them are positive, they only need a prophylaxis of moher-to-child transmission when being pregnant, not PrEP. Or you ask "what if" or about another, non-infected wife :)
I have quite the same question and the same answers. Your request is not perfectly clear.
If the husband is HIV positive, he needs to be treated by HAART and to maintain indetectable viral load, without STI. And then he should not transmit and intercourse without protection can take place if there is the objective of a pregnancy (or eventually PREP just at request at the moment of sexual intercourse to get pregnant.
If the husband and the wifes are already contaminated all, the only thing is to treat everybody (man and women), this allowing to prevent mother to child infection in te same time.
What i meant was that the Husband was Positive and wives were negative , after 2 years one of them became positive then second followed suit two years later subsequently , then the third and lastly the forth 9 years later. could ARV prophylaxis prevent this scene , there are many family in this situation and at risk.
If that, the answer is: yes, ARV prophylaxis can decrease a risk of infection. But in my opinion, better way is effective ARV treatment for husband. If the viral load is undetectable, the risk of transmission is near to zero (you can search for the latest results of "PARTNER study"). The treatment can lower the viral load but if it is effective - a patient should be given the most appropriate medicines and he or she should be adherent. This is called "treatment as prevention".
PrEP (pre exposure prophylaxis) can of course also work but but there is a risk of side effects of medicines in someone who is not infected. Besides, the costs are higher - you have to offer treatmet to someone who is infected with HIV and someone who is not. It would be a good option if the person living with HIV doesn't want treatment or is not adherent and his or her viral load is detectable. :)
viral load count are not available in many developing setting, we only monitor indirectly thru CD4, so the scenario above is common and is fueling the circle of new infection especially the female folks
I agree with previous comments. Early ART initiation is essential to prevent HIV transmission in serodiscordant couple. These recommendation from HPTN 052 trial is already included in current WHO guidelines. In developing countries with plasma viral testing not available, adherence to the ART medication is important. Early ART and >90% adherence is key to control the infection. In this case all of them would require life long ART. Pre exposure ARV prophylaxis would be helpful for new seronegative partner.
Thank you Santosh, i believe that this principle need to be included into the Protocol for HIV ,management , if we are to achieve very low rate of new infections, if this is ignored by WHO , then the circle would continue.
Education about adherence is very improtant. A lot of people taking ARVs could achieve undetectable viral load (regardless if it is monitored or not) if they were adherent. And a lot of people do not take their medicines as prescribed. I don't know how it is in your country, but working with people living with HIV in my country I see that some of them are not adherent. But those who take their medicines have (in most cases) very low viral load. So I think, education can be one (but really important) option.
Pre exposure prophylaxis is another option and it could be useful but there is also a need of edutation about those medicines and the need of monitoring side effects in patients on PrEP. And you need some solutions in the area of paying for ARVs. Who would pay for it? Those families? Would they have money for it? Or maybe blic health care would pay? But is there a legal possibility to provide free of charge treatment to non-infected people? If there's not - maybe there could be a way to create such possibilities?
Now when you have written more, I can understand your question a bit better. This discussion (and learning about the circumstances of your work) is very inspiring for me - thank you.
Thank you , The Drugs cost are covered through the Public Medical care and International Support, Free of Charge , However , they tend to be Bug-down with Protocol because of Underlying protection of Interest in-terms of cost.
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