AFJOG

REVIEW African Journal of Obstetrics and Gynaecology | Volume 2 | Issue 3 | 2024 | Pre-Exposure Prophylaxis to prevent HIV infection during Pregnancy and Breast-feeding: A South African Perspective population for future HIV prevention strategies as they are at increased risk of HIV acquisition, relative to the general population. This vulnerable population of women continues to be excluded from pivotal trials, due to ethical considerations. Frameworks for safe and ethical inclusion of PBFW before regulatory submissions of trials have already been successfully pioneered (103) . Accelerated safe and ethical inclusion of PBFW in HIV prevention trials is, therefore, possible and must be prioritized. Pivotal studies in the pipeline must aim to provide robust safety and efficacy data on the available options for PrEP among target populations. An HIV-1 vaccine that is safe, effective, and able to mount a durable immune response continues to be elusive. The application of m-RNA technology in the production of HIV vaccines presents unimaginable possibilities. Experimental HIV m-RNA vaccines are currently being evaluated and a full publication is awaited with great anticipation (97,98) . As novel therapies continue to be developed at an alarming pace and with more pivotal studies in the pipeline, the eradication of new HIV infections and perinatal transmissions is now feasible. The development of long-acting formulations has been a revelation. Not only can these agents be utilized for PrEP, but also for the treatment of people living with HIV. In 2021, the FDA approved the first combination injectable long-acting ART (LA-ART), administered intramuscularly every two months, for the treatment of HIV infection. (104,105) . The addition of LEN to the growing list of HIV prevention options, including oral PrEP containing TDF and TAF (2015 and 2019 respectively), DVR (2021) and CAB-LA (2022), can expand the toolkit for global HIV prevention efforts, especially for regions and communities with high HIV incidence. Current evidence only supports the safe use of TDF-based oral PrEP and the DVR during pregnancy and breastfeeding. More PrEP options need to be developed and prioritized for regulatory approval, as no one biomedical prevention option will fulfil the needs of all individuals. Pregnant and breastfeeding womenmust be counselled on the limited options available to them, the importance of adherence to therapy and the extreme risk of mother-to-child transmission, in the case of incidental HIV infection. Individuals currently on PrEP must also be counselled on the risk of infection with resistant strains, in the case of breakthrough HIV infection. Pre- exposure prophylaxis must be stopped immediately in the case of confirmed HIV infection and lifelong ART promptly initiated (22) . Scaling-up of PrEP services, especially for HIV-uninfected AGYW and PBFW, along with lifelong ART for people living with HIV is crucial in the eradication of perinatal transmission of HIV worldwide. The elimination of mother-to-child transmission of HIV is a global emergency and is possible, now more than ever (18) . Political will is key in increasing access to PrEP to all target populations, especially in overburdened communities. The fight against new HIV infections is ongoing, with WHO reporting 1.3 million new HIV infections in 2023 (4) . It must be emphasized to individuals initiating PrEP, that PrEP does not prevent other sexually transmitted infections. Pre-exposure prophylaxis should be an additional prevention choice in a comprehensive package of services. REFERENCES _ _ _ ¡ ¢ ¢ £ £ £ ¤ ¥ £ ¢ ¢ ¦ £ ¦¢ ¢ § ¦ ¡ ¡ _ l_ _ _ _ § ¨ _ _ _ _ _ £ £ ¦ ¦ ¦ ¡ ¡ © © © © © © © ©© ¦ £ _ ª « ¡ ª « ¦ ¡ £ £ African Journal of Obstetrics and Gynaecology | Volume 2 | Issue 3 | 2024 | 14