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HIV Testing of Pregnant Women
Routine human immunodeficiency virus (HIV) prenatal testing is the current recommendation from the American College of Obstetricians and Gynecologists (ACOG) and from the Institute of Medicine (IOM). The IOM outlined new recommendations in 1998 and ACOG released similar guidelines in 2000.
Background
In 1994, federal guidelines for prenatal HIV testing were developed because of new therapy that reduced the chance for women infected with the HIV virus to pass it to their children.
The guidelines at that time recommended that health care providers give detailed pre-test counseling to all pregnant women, explaining the risks of AIDS and the benefits of being tested.
While prenatal HIV testing and treatment seemed to increase after the 1994 guidelines were released, many health care providers were only suggesting HIV prenatal testing to those women considered high risk for HIV infection. Therefore, many women were still not being tested or treated and the number of children born with HIV was still unacceptably high, according to the 1998 IOM report.
The prediction is that by offering HIV testing routinely to ALL pregnant women, more women would be identified and treated for HIV, and this would decrease the number of children born with HIV.
Current Status of HIV Testing
As of July 2001, there is no federal law mandating prenatal HIV testing, just recommendations by the IOM and ACOG. Connecticut is the only state that has mandatory HIV testing.
You will likely still have a choice as to whether you want to have a prenatal HIV test. At some point, HIV testing may become part of routine prenatal testing.
Pregnant Women with HIV
Prevention of transmission of HIV from mother to fetus (vertical transmission) is a major goal in the care of pregnant women with HIV. Earlier studies have shown that treatment of the mother with Zidovudine (AZT) during pregnancy and labor and of the newborn could reduce the transmission rate from 25% to 8%. A recent study published in 1999 has demonstrated that when care includes both AZT therapy and scheduled cesarean delivery, the risk of vertical transmission is decreased to 2%. As with all complex clinical decisions, the choice of delivery must be individualized. No combination of therapies can guarantee that a newborn will not become infected (a 0% transmission rate). Choosing to have a cesarean section will obviously bring greater risks for the mother. You should talk to your obstetrician and discuss the option of scheduled cesarean delivery as early as possible in pregnancy if you are infected with HIV.
Reviewed By: Peter Chen, M.D., Obstetrics and Gynecology, University of Pennsylvania School of Medicine. Review provided by VeriMed Healthcare Network.
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