As an empathetic medical physician, Dr Theron Moodley leverages years of experience in Obstetrics and Gynecology. Improving patients’ quality and promoting health via changes in medical education, research, and patient care is at the core of his vision across the community and organizations. Known for innovative, influential and authentic leadership style and tactical thinking, Dr Theron Moodley helps move challenging and large-scale initiatives forward. With Skills in consensus, relationship, and strategic partnerships building, Dr Theron takes pride in his research to eliminate pediatric HIV infections.
For a long time, Dr. Theron Moodley has maintained that HIV and mother-to-child transmission of the disease remain global problems. As of 2015, 36.7 million people worldwide were living with HIV. Worldwide, 6% to 20% of all maternal deaths are related to HIV. The predominant association is infectious disease complications associated with HIV.
The estimated worldwide rate of mother-to-child transmission is 14%. Still, it is less than 1% in the United States due to the success of antiretroviral therapy (ART). In the United States alone, Dr. Theron Moodley posits there is a perception that HIV has become less of a public health issue.
The goal of this article is to summarize the recommendations by Dr. Theron Moodley for the care of pregnant women with HIV, highlighting recent changes in the guidance, which could bring us closer to our goal to eliminate mother-to-child transmission of HIV.
How Dr. Theron Moodley Views OB’s Role in HIV Management in Pregnancy
For Dr. Theron Moodley, the goal of eliminating mother-to-child transmission remains elusive. Yet, it has been attained in countries with fewer economic resources. There are several barriers to eliminating mother-to-child transmissions, such as lack of access to healthcare, family planning, HIV testing, and preconception counseling. Significant racial and ethnic disparities are apparent.
According to Dr. Theron Moodley, infants born to African-American women with HIV are 50 times more likely than infants born to white women and eight times more likely than Hispanic infants to be perinatally infected with HIV. These trends in the United States have not changed over the past decade.
The complex cascade of interventions required to reduce further mother-to-child transmission relies heavily on the OB/GYN. The “Recommendations for the Use of Antiretroviral Drugs in Pregnant Women with HIV Infection and Interventions to Reduce Perinatal HIV Transmission in the United States” (HIV Perinatal Guidelines) are updated regularly as new data emerge provide the most comprehensive recommendations for care of women and babies.
Preconception Counseling: Effective and Safe Conception
Many men and women with HIV desire children. Still, as Dr. Theron Moodley’s data suggest, their providers fail to discuss family planning goals. A study of 181 women with HIV found that only 31% reported a personalized discussion with their provider about childbearing plans. The patient rather than the provider typically initiated those conversations.
Discussion about pregnancy desires should occur during routine appointments, including primary care, well-woman exams, and infectious disease visits. Dr. Theron Moodley states that women can receive counseling regarding safe methods of conception or appropriate contraceptive options.
A World Health Organization expert group reviewed the evidence regarding drug-drug interactions and hormonal contraception. As per their suggestions, Dr. Theron Moodley recommends that women with HIV continue to use all existing methods without restriction. However, some forms of ART can interact with hormonal contraceptives, decreasing the efficacy of the contraceptives.
Critical Components to Reduce Transmission
Below are vital components that Dr. Theron Moodley suggests to reduce transmission in HIV-discordant couples (i.e., one partner is HIV-positive and the other HIV-negative) that desire pregnancy:
- Couples should be tested and treated for other sexually transmitted infections before attempting conception.
- HIV-positive women contemplating pregnancy should be on an antiretroviral (ARV) regimen with a low risk of teratogenicity.
- HIV-positive partners should have a suppressed (undetectable) viral load before conception.
Pre-exposure prophylaxis (PrEP) should be offered for 30 days before and 30 days after attempting conception, or for as long as the risk of HIV acquisition persists, such as remaining sexually active without barrier protection with condoms.
For Dr. Theron Moodley, it is imperative when the HIV-positive partner has not achieved viral suppression, or the viral status is unknown.
HIV-Positive Women in a Discordant Couple
For HIV-positive women in a discordant couple, options according to Dr. Theron Moodley include:
- Assisted insemination at home or in a provider’s office with a partner’s semen during the peri-ovulatory period
- Adding PrEP for the male partner as outlined above PLUS timed intercourse, which may further decrease the risk of HIV for her partner
HIV-Positive Men
For HIV-positive men, Dr. Theron Moodley suggests the following options:
- Artificial insemination with donor sperm from an HIV-uninfected man or with washed sperm coupled with PrEP for the female partner.
- Although PrEP can decrease HIV acquisition, is approved by the US Food and Drug Administration and has been recommended by the Centers for Disease Control and Prevention (CDC) for these high-risk individuals since 2012, it is under-utilized, particularly in women.
- PrEP is once-daily tenofovir/emtricitabine (Truvada). Importantly, breastfeeding and pregnancy are not contraindications to PrEP. Studies have shown low if not undetectable levels of the medication in breast milk.