ACOG Updates Recommendations for Prenatal HIV Testing

Beth Skwarecki

May 27, 2015

New guidelines for HIV testing in pregnancy recognize that early detection and treatment can benefit the mother and her sexual partners, as well as the infant. The American College of Obstetricians and Gynecologists published the updated guidelines, which replace a 2008 committee opinion, in the June issue of Obstetrics & Gynecology.

"There are more reasons than ever to identify pregnant women who have HIV," said author Denise Jamieson, MD, chief of the Women's Health and Fertility Branch at the Centers for Disease Control and Prevention, Atlanta, Georgia. Previously, HIV prophylaxis was focused on preventing transmission to the baby, and women would often be treated with antiretrovirals during pregnancy, but taken off the drugs after birth. "Now, with the emphasis on earlier treatment [for all HIV patients], the vast majority of women who are identified during pregnancy will stay on antiretrovirals after their pregnancy."

That said, "the basics of who should be screened, and how often, have not changed," Dr Jamieson told Medscape Medical News.

Those basics are:

  • 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.

Antiretrovirals can prevent the chance of an HIV-positive woman passing the virus to an uninfected partner, so treatment is now understood to benefit the mother, baby, and the mother's partner, rather than just the baby.

Testing technology has also changed since the guidelines were last issued. Previous testing relied on antibody screening, but current screening uses combined antibody and antigen tests, as well as testing for viral RNA. As a result, tests can detect infections earlier, within weeks rather than months.

The authors have disclosed no relevant financial relationships.

Obstet Gynecol. 2015;125:1544-1547. Full text

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