What are the ACOG guidelines on HIV testing during pregnancy?

Updated: Jul 01, 2019
  • Author: Nicholas John Bennett, MBBCh, PhD, MA(Cantab), FAAP; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Guidelines issued in 2015 on HIV testing during pregnancy by the American College of Obstetricians and Gynecologists are as follows: [93, 94]

  • Women should be tested for HIV during routine prenatal testing, on an opt-out basis when possible.
  • Women at high risk for HIV infection, including injection drug users and women with multiple sex partners during their pregnancy, should be retested in their third trimester.
  • Women who have not been tested should be offered rapid screening when in labor; if the rapid test result is positive, antiretroviral therapy should be initiated while awaiting results of a confirmatory test.
  • All pregnant women should be screened for HIV infection as early as possible during each pregnancy using the opt-out approach when allowed.
  • Repeat HIV testing in the third trimester is recommended among women in areas with high HIV incidence or prevalence and among women known to be at risk for acquiring HIV infection.
  • Women who were not tested earlier in pregnancy or whose HIV status is otherwise undocumented should be offered rapid screening upon labor and delivery using the opt-out approach when allowed.
  • If a rapid HIV test result in labor is reactive, antiretroviral prophylaxis should be immediately initiated while awaiting supplemental test results.
  • If the diagnosis of HIV infection is established, the woman should be linked into ongoing care with a specialist in HIV care for comanagement.

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