What are the ACOG guidelines on HIV testing during pregnancy?

Updated: Mar 05, 2020
  • Author: Delia M Rivera, MD; Chief Editor: Russell W Steele, MD  more...
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Answer

The American College of Obstetricians and Gynecologists updated their guidelines on HIV testing during pregnancy. [34, 35] The new guidelines include the following:

  • Women should be tested for HIV during routine prenatal testing, on an opt-out basis where possible.
  • Women at high risk for HIV, including injection drug users and women with multiple sex partners during their pregnancy, should be tested again in their third trimester.
  • Women who have not been tested should be offered rapid screening when in labor, and if the rapid test is positive, they should start antiretroviral therapy while waiting for results from a confirmatory test.
  • All pregnant women should be screened for HIV infection as early as possible during each pregnancy using the opt-out approach where allowed.

  • Repeat HIV testing in the third trimester is recommended for women in areas with high HIV incidence or prevalence and for women known to be at risk of acquiring HIV infection.

  • Women who were not tested earlier in pregnancy or whose HIV status is otherwise undocumented should be offered rapid screening on labor and delivery using the opt-out approach where allowed.

  • If a rapid HIV test result in labor is reactive, antiretroviral prophylaxis should be immediately initiated while waiting for 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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