PrEP & Pregnancy?! Yes it is possible. Karl speaks with Dr. Charlene Flash about women, pregnancy, and PrEP.

The following is a transcript of the conversation between Karl and Dr. Flash

DR. FLASH
PrEP allows the woman to protect herself, to have that barrier of protection…

KARL
Welcome to “+TALK” on +LIFE. I’m joined by Dr. Charlene Flash today. She’s the president and CEO of Avenue 360 Health and Wellness in Houston. And we’re talking PrEP and pregnancy. Good to see you, doc.

DR. FLASH
Good to see you, Karl. Happy to be here.

KARL
Thanks for making the time. Let’s dive straight in. What is PrEP?

DR. FLASH
PrEP is HIV pre-exposure prophylaxis. So what that means in English is PrEP is a medication that people can take to protect them from becoming infected with HIV. KARL
So like condomless sex, right?

DR. FLASH
It can be with a condom or without a condom.

KARL
Okay.

DR. FLASH
Taking PrEP doesn’t drive your condom use, but it does drive your ability to protect yourself from HIV. And right now, we have three options: two different pills and one injectable.

KARL
How does it work?

DR. FLASH
So that’s an interesting question. Basically, PrEP takes medication that has historically been used as part of HIV drug treatment cocktails to create a barrier of protection for individuals who are at risk for HIV, to protect them from becoming infected. The mechanism of action isn’t totally clear, but we know that when you give this medication to thousands and thousands of people that are at risk and you give a sugar pill to thousands of thousands of people who are not at risk, the people who are on PrEP are protected from becoming infected with HIV.

KARL
So let’s talk from a female’s perspective. You can do that better than I can, obviously, because I think we hear PrEP a lot. People think, “Oh, it’s for gay dudes.” Predominantly, I think it’s been marketed a lot like that, you know. But if I’m a female in a serodiscordant relationship, that is to say, my partner is positive and I’m negative, is PrEP a good idea for me?

DR. FLASH
It can be. And so when I think about people who are in a relationship or people who are about to engage in intercourse, I try to stay away from discourse because that’s never good in a relationship. So I think about them as serodifferent couples. And so when people are serodifferent and they’re looking for options on how to protect them, some of the medications that can be used as PrEP are available to women. Not all. So there are two different by mouth pills. The older one can be used for women. The newer one, we just don’t have the data yet.

KARL
If I’m wanting to get pregnant and my partner is HIV positive, again, I’m speaking from a female’s perspective here, can we, and is PrEP a good tool in that?

DR. FLASH
All right, so if a woman is with a sexual partner, a male sexual partner, and she says, “Gosh, you know, I really wanna get pregnant, is this even an option for me?” Absolutely, yes. We have lots of women who are able to not only get pregnant but safely get pregnant, such that they don’t get infected with HIV and their baby is not infected. So those are the really important criteria. So there are different ways to go about this. Now, you can do it the old fashioned way, which is, one, make sure that your sexual partner is on treatment himself, that his level of virus is completely controlled, so at an undetectable level, and that he’s actually continuously taking his medication. So you don’t wanna see lab results from like two years ago, right? If you’re trying to make the baby right now, you wanna see his lab results from right now so that you know that his level of virus is well-controlled. And then in those settings, though often we encourage people to use condoms to protect them from syphilis, gonorrhea, chlamydia, that doesn’t work if you’re trying to make a baby. Right? And so we wanna make sure that your sexual partner has no circulating virus so that you guys can make a baby and not worry about you getting infected or the baby getting infected. Now, the amazing thing about PrEP is you now have additional options as a woman, so you don’t have to trust, is this guy really taking his meds, and are these today’s labs or is this the labs from 10 years ago and they, you know, no longer are relevant. And so PrEP allows the woman to protect herself, to have that barrier of protection to protect herself from getting infected while she’s having condomless sex with her male partner so that she can have a baby, the baby doesn’t have HIV, she doesn’t have an HIV. And you know, he’s taking his meds or he is not, but she has the control in her hands to be able to protect herself.

KARL
So how long should a female start taking PrEP? If this is a conversation that she’s having with her partner and they want to go down this path, is there a right time to start that’s better than, say, do I do it a week before, a month before? How long is typically advised?

DR. FLASH
Yes, and so for the medication that’s taken by mouth, to get to the appropriate drug levels to provide protection, the science says you need at least 21 days to get appropriate drug levels. What I tell people is start the month before, right? So you have your cycle, start your PrEP, and then, you know, have a month pass and then try and have fun trying.

KARL
Very important to have fun trying. What about side effects? Because a lot of people talk about, “Oh, you know, I don’t wanna put another drug in my system.” Let’s talk specifically from a female perspective and a female who is wanting to get pregnant. What are the potential side effects?

DR. FLASH
So the side effects are few and they are rare. The most common thing that happens with people who take PrEP is that they have weight loss without trying. And, well, for most women in America, they would say, “Hey, maybe that’s a good thing.”

KARL
That’s not such a bad thing.

DR. FLASH
Yeah, exactly. And so some people can have some stomach upset as well. Now, if someone has other medical problems, that can make it a little more complicated. So if I wanna get on PrEP and I already have another medical problem that causes damage to my kidneys, for example, PrEP does put pressure on the kidneys as well. And so in the setting of having not totally normal kidneys, that might be a problem for the woman. And the other thing to think about is that in the long term, PrEP can cause decreases in what we call bone mineral density, so how dense or how, you know, hard and strong your bones are, which is something to think about for women. Because as women age and get outside of that time of their life where they’re having babies and you get into that post-menopausal stage, their bones tend to thin anyway and they tend to be at risk for osteoporosis. And so it’s important to just think about, “Well, is there anything else that could be driving thin bones for this woman,” as I’m thinking about PrEP as a long-term solution. Now, just because you’ve decided to take PrEP as part of the I’m-trying-to-make-a-baby experience doesn’t mean that you have to use it forever. And so that is also a way for you to decrease or mitigate risk.

KARL
I was gonna ask, once we’ve successfully made the baby and the baby is cooking away, do I have to stay on PrEP if I’m a woman, or can I start to come off PrEP while, you know, baby is still inside?

DR. FLASH
Great question. So you’ve made the baby, baby is cooking, as you say. You know, I really believe in shared decision-making. So it really depends. Now, if this sexual partner is your ongoing partner, right? You have this ongoing partner and you are still having intercourse, ’cause yes, people do have intercourse while they are pregnant, then PrEP may still be a good idea for you, especially if you are not navigating condoms during that timeframe, or if the partner doesn’t have well-controlled virus, right? They kind of get depressed, come off their meds, or whatever’s happening. So PrEP may be an option for you. Now, whenever you talk about women who are pregnant taking medication, everybody freaks out, and says, “Oh my goodness, what’s gonna happen to the pregnancy?” Well, the good news is that the ingredients that are in the kind of PrEP that women take in this setting are also the same ingredients that we’ve been using for years to treat children who have HIV. And so we know that these medications, that children do well because we have lots of data about what happens with children who’ve been exposed to these medications. Now, what I tell folks is suppose you… You know, people have all kinds of thoughts about making babies, right? And so you start a month before, you’re on your PrEp, you’re like, “Okay. Ready, here we go.” And you have your try. And so maybe this isn’t the kind of relationship where you are, you know, you’re living together and as you’re trying every day, but it’s like he flies in from the other coast, right? So the other part of the question is, “Do I just take it up until that day and then I stop?” Well, I generally tell people in this setting that you also want a tail of protection. So you wanna continue after the intercourse, if it happens to just be a, you know, kind of one try, though that often is not the best way to make a baby. We have to, you know, try a couple of times. And so during that entire season, PrEP is a good idea. Now, there is something else out there that men can do, but doesn’t work for women, and this is on-demand PrEP, right? So gay men are able to take a couple of doses, right before they have sex, and they take a dose the day after and the day after that, and are able to be protected. We don’t have any data that proves that that actually works for women. So don’t do that. So if you go to Dr. Google and he says, “Let’s do on-demand PrEP, just four tablets, you know, a couple of days before and after,” don’t do that, it doesn’t work. And it will not protect you appropriately or protect the baby.

KARL
Dr. Charlene Flash, this has been great. Thank you so much for making the time and having this chat with us.

DR. FLASH
Oh, it was my pleasure. Thank you for having me.

KARL
If you want more information about what we’ve talked about today, go to the website pluslifemedia.com. And you can always follow us on social media, we are @PLUSLIFEMEDIA. Until next time, take care. See ya.