Owing to an increase in the
number of HIV-infected women of childbearing age, the number of children
infected with HIV has risen dramatically. As part of the routine antenatal
Therefore, it is critical that
pregnant women infected with HIV should be accurately identified in a timely
manner, and measures should be undertaken to decrease the risk of HIV
transmission from mother to child and also to optimize the mother's health. Antiretroviral
medications given to a HIV positive woman during pregnancy
delivery; and to their newborns in the first weeks of life reduces the rate of
vertical transmission from 25% to 2% or less.
New evidence also suggests that
early initiation of antiretroviral therapy in the course of HIV infection
reduces the rate of sexual transmission to partners who are not infected.
conventional method for HIV diagnosis involves a reactive antibody-screening
test followed by Western Blot confirmation. Since antibody testing alone might
miss a considerable number of HIV infections that are detectable by virologic
tests, newer antibody-antigen
combination screening tests are now recommended
. The screening should be performed as early as possible during each
Women should be notified that HIV screening is recommended for
all pregnant patients and that they will undergo a HIV screening test as part
of the routine prenatal tests unless they decline (opt out screening approach
where allowed). If a woman declines HIV testing, the obstetric provider should
document this in the medical record and should discuss and address the
patient's reasons for declining an HIV test.
Women who present late in pregnancy or in labor
with undocumented HIV status should be offered rapid testing by using an HIV test
that provides preliminary results in less than one hour.
If a rapid
test is reactive, immediate initiation of antiretroviral prophylaxis for mother
and neonate is recommended without waiting for the results of supplemental
tests. All antiretroviral prophylaxis should be discontinued if supplemental
testing results are negative.
Academy of Pediatrics advises that infants
born to women whose HIV status is unknown (due to opt out approach) should be
subjected to a rapid antibody test performed as soon as possible after birth.
Women should be informed of all tests performed on their neonates, and based on
these results the mother and neonate must be provided with appropriate and
Repeat HIV testing in the third trimester of pregnancy
before 36 weeks of gestation, is recommended for women living in areas with
high HIV incidence and women known to be at a higher risk of acquiring HIV
infection. Repeat testing is also recommended in areas with elevated AIDS
incidence and in health care facilities that identify at least one pregnant
woman infected with HIV per 1,000 women during prenatal screening. Women who
have signs or symptoms consistently with acute HIV infection such as fever,
, myalgia, headache, oral
ulcers, leukopenia, or thrombocytopenia
should also be retested.
If a pregnant
woman's HIV test results are positive, she should be given her results in
person. The healthcare facility should provide
counseling to women regarding the
implications of HIV infection and the risks of transmission to the child
Additional laboratory tests, including CD4+
count, HIV viral load,
testing for antiretroviral resistance, hepatitis
virus antibody and hepatitis B
surface antigen will be useful before prescribing an antiretroviral therapy.
Once the diagnosis of HIV infection is established, the woman should also be linked to ongoing care with a specialist in HIV
care for co-management
of her condition. In addition, the patient should be
counseled on the importance of notifying her sexual partners about her HIV
status and the importance of HIV testing for any sexual partner. Obstetricians
should be aware of and comply with their states' legal requirements regarding
partner notification and disclosure of HIV status to others, including the
These recommendations have been made
by the American College of Obstetricians and Gynecologists and will help in
controlling the mother-to-baby transmission of HIV.