Widespread prenatal HIV screening and use of antiretroviral drugs in pregnant HIV-infected women is needed

Rapid testing during labor can enable pregnant women with undocumented HIV status to learn their HIV infection status so they can receive antiretroviral prophylaxis and be referred for comprehensive medical care and follow-up according to a report in the current issue of the Journal of the American Medical Association.

Co-author Mardge H. Cohen, M.D., from Cook County Hospital, Chicago, presented the findings from the paper at the International AIDS Conference in Bangkok, Thailand.

"The Centers for Disease Control and Prevention (CDC) estimates that between 280 and 370 infants are born infected with human immunodeficiency virus (HIV) annually in the United States despite recommendations for universal prenatal HIV screening and widespread use of antiretroviral drugs in pregnant HIV-infected women," the authors provide as background information. "Perinatally [near birth] acquired HIV infections may result from missed opportunities for prevention, such as inadequate prenatal care. Ideally, all pregnant women should receive early prenatal care with voluntary HIV testing."

Lead author Marc Bulterys, M.D., Ph.D., from the National Center for HIV, STD, and TB Prevention at the CDC, and colleagues, analyzed the results from the Mother-Infant Rapid Intervention At Delivery (MIRIAD) study that implemented 24-hour counseling and voluntary rapid HIV testing for women in labor at 16 U.S. hospitals from November 16, 2001 through November 15, 2003.

There were 91,707 visits to the labor and delivery units in the study; 7,381 (8 percent of all visits recorded) of which were by eligible women without documentation of HIV testing. A total of 4,849 eligible women participated in the study. Blood samples were collected for both rapid testing and enzyme immunoassay (EIA), and if needed, Western blot testing.

"Factors independently associated with higher test acceptance included younger age, being black or Hispanic, gestational age less than 32 weeks, and having had no prenatal care," the authors report. In addition, "Median (mid-point) time from blood collection to patient notification of rapid test result was 66 minutes. In contrast, the median time from blood collection to receipt of EIA results was 28 hours, with more significant delays for specimens obtained on weekends vs. weekdays (39 vs. 25 hours)." ... "Thirty-four women tested HIV-1 positive with both rapid test and EIA, and all were confirmed by Western blot (prevalence = 7/1,000)," the authors found. For HIV-positive women identified, the median time between receipt of rapid test result and zidovudine prophylaxis provided to the mother in labor was 33 minutes. All HIV-exposed infants received antiretroviral prophylaxis soon after birth. To date, three infants in this study were found to be HIV-infected.

"The MIRIAD findings are important both in the United States and internationally. In many settings, including in the developing world, pregnant women with unknown HIV status are often seen by clinicians for the first time during labor. Rapid testing during labor can enable pregnant women with undocumented HIV status to learn their HIV infection status so they can receive antiretroviral prophylaxis and be referred for comprehensive medical care and follow-up," the authors conclude.