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July 5, 2005 -- An HIV test should be added to the list of medical tests every woman in the U.S. receives during pregnancy, according to new guidelines.
"Having a test for HIV during pregnancy is one more thing a woman can to do to try to assure having a healthy infant," says Diana Petitti, MD, vice-chair of the U.S. Preventive Services Task Force (USPSTF), which issued the guidelines, in a news release.
The new guidelines update the 1996 recommendations of the task force, which called for HIV screening and counseling for high-risk pregnant women and women living in areas with high rates of HIV-infected newborns.
Researchers say they revised the guidelines in light of new research that shows treatment can safely reduce the odds of an HIV-infected mother passing the virus along to her infant from up to about one in four to nearly one in 100.
Early detection of maternal HIV infection also allows for discussion of elective cesarean section and avoidance of breastfeeding, both of which are associated with lower HIV transmission rates, they write.
The new guidelines also broaden the definition of people considered at high risk for HIV infection who should be targeted for HIV screening.
HIV Screening for All Pregnant Women
Researchers say an estimated 850,000 to 950,000 Americans are infected with HIV. Of those, nearly a quarter do not know that they have the virus. If untreated, nearly all HIV-infected persons will eventually develop AIDS.
Women have become the fastest growing group of people being newly diagnosed with HIV each year. Researchers say targeting HIV screening to high-risk pregnant women and women living in areas with high rates of HIV-infected newborns would miss a large number of women who don't report any risk factors.
The task force says there is recent evidence that prenatal counseling and HIV testing have gained wider acceptance among pregnant women, and that universal HIV screening increases the number of women diagnosed and treated for HIV during pregnancy.
Mother-to-child transmission of HIV infection can occur during pregnancy, during labor and delivery, and after delivery.
Recommended treatments include drug therapy that has been found safe for pregnant women, mothers, and infants. These therapies can reduce the risk of an HIV-infected mother passing the virus to her infant from up to 25% to 1%.
Panel Broadens High Risk HIV Category
Since the publication of the 1996 HIV screening guidelines, there have been advancements in treating HIV infection with Highly Active Antiretroviral Therapy (HAART), which uses three or more medications in combination. HAART has been shown to dramatically slow the progression of the disease as well as reduce HIV-related death rates.
Those advances call for more vigilant HIV testing among people at high risk for the disease, says the task force.
The new HIV screening guidelines broaden the definition of high risk to include people who not only report one or more individual risk factors for HIV but also those who live or seek treatment in areas with a high prevalence of the disease, including homeless shelters and clinics devoted to the treatment of sexually transmitted diseases.
Individual risk factors for HIV include:
The complete guidelines appear in the July 5 issue of the Annals of Internal Medicine.
The USPSTF is an independent panel of experts in prevention and primary care that carries no authority to implement its recommendations. But many doctors, clinics, insurance companies, and other medical organizations follow or endorse the panel's recommendations.
SOURCES: Chou, R. Annals of Internal Medicine, July 5, 2005; vol 143: pp 38-54, 55-73. News release, Agency for Healthcare Research and Quality.