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Background: Ritonavir‐boosted darunavir (DRV/r) is a preferred protease inhibitor in pregnant women living with HIV. Current practice at British Columbia's referral centre (the Oak Tree Clinic) is to dose DRV/r as 800/100 mg daily throughout pregnancy, although some guidelines recommend DRV/r 600/100 mg twice daily due to altered pharmacokinetics with once‐daily dosing. Objectives: We describe the effect of once‐daily DRV/r on viral suppression, vertical transmission, adverse drug effects and adherence in pregnant women living with HIV. Methods: This was a retrospective analysis of pregnant women living with HIV in British Columbia. Eligible women gave birth between January 2015 and August 2021, and took DRV/r 800/100 mg daily at any time during pregnancy. Results: Thirty‐four women were included in this study. The mean (SD) age was 33 (5) years. Thirty (88%) women were diagnosed with HIV prior to pregnancy, with 22 (73%) having viral suppression at baseline. Four (12%) were diagnosed in pregnancy, with a median baseline viral load of 9616 copies/mL (range 8370–165 000). Viral suppression was achieved by 16 (100%), 24 (75%) and 26 (74%) women in the first, second and third trimesters, respectively. No vertical transmission occurred. This combination was well tolerated, with adverse drug effects that did not result in discontinuation or change in therapy. Most women maintained >75% adherence to once‐daily DRV/r at all times during pregnancy. Conclusions: Ritonavir‐boosted darunavir 800/100 mg daily appears to be an appropriate dosing strategy for pregnant women living with HIV who are able to maintain optimal adherence. [ABSTRACT FROM AUTHOR]

Introduction: Rates of unintended pregnancy are higher in women living with HIV than in those without HIV. The World Health Organization and the Canadian HIV Pregnancy Planning Guidelines recommend preventing unintended pregnancies and offering contraception counselling to women living with HIV to reduce the rate of perinatal HIV transmission worldwide. No studies have assessed post‐partum (PP) contraception use in women living with HIV in Canada. Methods: We conducted a retrospective chart review including all women living with HIV followed by the Oak Tree Clinic who had a live birth between 1 January 2014 and 15 September 2019. The main objective was to quantify the proportion and types of contraception used by women living with HIV within 3 months PP and to evaluate whether contraception counselling is associated with contraception use. Results: Of the 110 participants included, 79% were using contraception within 3 months PP. The most common contraception methods used were an intrauterine device in 22% of participants followed by depot‐medroxyprogesterone acetate in 18% of participants. Of those intending to use contraception PP, 86% and 92% were using contraception within 3 and 12 months PP, respectively. Contraception counselling during pregnancy, and up to 3 months PP, was associated with contraception use within 3 months PP (p < 0.05). Conclusion: The majority of women were using contraception within 3 months PP. Having a contraception plan resulted in a high rate of contraception use. Women living with HIV should have a PP contraception plan prior to giving birth to establish the necessary steps for starting highly reliable forms of contraception. Contraception counselling was associated with contraception use and should be incorporated during pregnancy and in the immediate PP period. [ABSTRACT FROM AUTHOR]

Background: Women represent one quarter of the population living with HIV in Canada and are an increasingly important sector of the HIV community. While some women's health issues such as cervical cancer screening and management are well addressed in HIV management guidelines, others are not. These include sexual and reproductive health factors such as contraception, pre-conception planning, and menopause. Existing literature has shown that while women living with HIV in Canada receive good HIV care based on HIV care cascade indicators, their women's health and sexual and reproductive health care needs are not being met., Methods: In this article, we present a clinical guide for clinicians providing care for women living with HIV on three key women's health topics that are under-discussed during HIV care visits: (1) contraception, (2) pre-conception planning, and (3) menopause., Results: We have summarized the most pertinent clinical factors on each topic to support straightforward counselling and present important considerations in the context of HIV-related diseases and treatment. Finally, when relevant, we have provided practical stepwise approaches for addressing each of these women's health care topics when seeing a patient during a visit., Conclusions: It is important that HIV specialists stay well-versed in the complex clinical interactions between HIV treatment and management of women's health issues., (Copyright © 2021, Association of Medical Microbiology and Infectious Disease Canada (AMMI Canada).)