Q: What is U=U?

U=U stands for undetectable = untransmittable. It is the slogan that has taken shape based on the evidence that people with undetectable viral loads cannot sexually transmit HIV.

Q: What is pre-exposure prophylaxis (PrEP) exactly and when should it be used when trying to get pregnant?

PrEP is the use of anti-HIV medication (the same kind of medication people living with HIV take to fight the virus inside their body) that keeps HIV negative people from becoming infected. Specifically, the anti-HIV medication consists of two antiretroviral drugs in a combination pill known as Truvada® and is taken as one pill per day. PrEP stops HIV from taking hold and spreading throughout the body. When taken daily, PrEP is highly effective for preventing HIV. PrEP is much less effective when it is not taken consistently.

Q: My patient is cis gender and in a heterosexual relationship. Can my patient with HIV just have sex?

Yes. If your patient is taking, and is adherent to their antiretroviral therapy regimens and their viral loads are undetectable (i.e., U=U) they can have condomless sex.

Q: Is HIV a specialized area of OB Care?

Infectious diseases are considered a specialized area of OBGYN care. However, there are many generalist OBGYNs in Canada who offer and feel very comfortable providing OB care to people living with HIV.

Q: Are there expert OBs and fertility clinics about HIV in Canada?

Yes, there are! If you are not aware of one in your area, please contact a member of the CHPPG team.(mailto:logan.kennedy@wchospital.ca?subject=Expert OB/Fertility clinic in my area re: HIV and pregnancy??) Access to fertility clinics for people with HIV has improved over time but is still regionally dependent and access to full ART remains limited.

Question 1

What is new in the field of HIV that I should know about?

Accepted Answer

Advancements in HIV over the past 20 years have been ground-breaking. From what was a certain death sentence, HIV has come to be a manageable chronic illness with the right care and support.
The most important advances to be aware of as an OB/GYN are:
 • HIV is now considered a chronic illness;
 • With as little as one pill, once a day, people living with HIV can fully suppress their viral load and live a long and healthy life;
 • When a person living with HIV has an undetectable viral load (< 50 copies/ml) or a low viral load (< 1,500 copies/mL) they are sexually uninfectious.  This means they CANNOT pass on HIV to their sexual partners;
 • When a person living with HIV becomes pregnant while virally suppressed, stays suppressed through pregnancy and delivery, and avoids breastfeeding their chance of transmitting HIV to the fetus is ZERO;
 • Despite all of the medical advancements, people living with HIV remain highly stigmatized without reason, particularly as it relates to parenting desires.

Question 2

What is U=U?

Accepted Answer

U=U stands for undetectable = untransmittable.  It is the slogan that has taken shape based on the evidence that people with undetectable viral loads cannot sexually transmit HIV.

Question 3

What is pre-exposure prophylaxis (PrEP) exactly and when should it be used when trying to get pregnant?

Accepted Answer

PrEP is the use of anti-HIV medication (the same kind of medication people living with HIV take to fight the virus inside their body) that keeps HIV negative people from becoming infected. Specifically, the anti-HIV medication consists of two antiretroviral drugs in a combination pill known as Truvada® and is taken as one pill per day. PrEP stops HIV from taking hold and spreading throughout the body. When taken daily, PrEP is highly effective for preventing HIV. PrEP is much less effective when it is not taken consistently.

Question 4

My patient is cis gender and in a heterosexual relationship. Can my patient with HIV just have sex?

Accepted Answer

Yes. If your patient is taking, and is adherent to their antiretroviral therapy regimens and their viral loads are undetectable (i.e., U=U) they can have condomless sex.

Question 5

Is HIV a specialized area of OB Care?

Accepted Answer

Infectious diseases are considered a specialized area of OBGYN care. However, there are many generalist OBGYNs in Canada who offer and feel very comfortable providing OB care to people living with HIV.

Question 6

Are there expert OBs and fertility clinics about HIV in Canada?

Accepted Answer

Yes, there are! If you are not aware of one in your area, please contact a member of the CHPPG team.(mailto:logan.kennedy@wchospital.ca?subject=Expert OB/Fertility clinic in my area re: HIV and pregnancy??)
Access to fertility clinics for people with HIV has improved over time but is still regionally dependent and access to full ART remains limited.