HIV Screening Recommended for All Pregnant Women

The U.S. Preventive Services Task Force issued a new recommendation calling for all pregnant women, not just those identified as at risk for contracting HIV, to be screened for the infection. This recommendation is based on evidence that currently available tests accurately identify pregnant women who are HIV infected and that recommended treatment strategies can dramatically reduce the chances that an infected mother will transmit HIV to her infant.

The Task Force also reaffirmed its earlier recommendation that all adolescents and adults at increased risk for HIV infection be screened and has broadened its definition of high-risk. In addition to patients who report high-risk behaviors, all patients receiving care in high-risk settings such as homeless shelters or clinics dedicated to the treatment of sexually transmitted diseases should be tested. The Task Force found at least fair evidence that screening adolescents and adults who are not at increased risk can improve health outcomes, but concluded that the balance of benefits and harms is too close to justify a general recommendation. The new recommendations are published in the July 5 issue of the Annals of Internal Medicine.

In 1996, the Task Force recommended a targeted strategy of routine counseling and screening of high-risk pregnant women and those who live in communities with a higher rate of HIV-positive newborns. However, recent evidence indicates that prenatal counseling and HIV testing has gained wider acceptance among pregnant women and that universal testing increases the number of women diagnosed and treated for HIV prior to delivery. Currently recommended treatment of HIV-infected pregnant women has been shown to significantly reduce the number of women who pass the virus to their newborns.

Treatment includes combination drug therapies taken during pregnancy that have been found safe for both mothers and infants. In addition, elective cesarean section and avoidance of breastfeeding have been shown to further reduce the chances of a womans passing HIV infection to her infant. Infected mothers who receive treatment can reduce the chance that their infants will be infected to as low as 1 percent, as opposed to 25 percent of infants born to HIV-positive mothers who arent treated during pregnancy.

This recommendation is an important advancement in reducing the rates of HIV in the United States, said Task Force vice chair Diana Petitti, MD, who also is senior scientific advisor for health policy and medicine for Kaiser Permanente Southern California. More accurate HIV testing during pregnancy and new treatments for HIV have been shown to be safe and effective for mothers and infants and may reduce the number of infants born with the disease.

Since 1995, advancements in treating HIV-positive patients with Highly Active Antiretroviral Therapy (HAART), a treatment regimen that combines three or more medications, have been shown to slow the progression of the disease as well as to reduce HIV-related death rates.

There are an estimated 850,000 to 950,000 Americans infected with HIV who are unaware that they have the virus. If left untreated, almost all infected individuals will develop acquired immunodeficiency syndrome (AIDS). AIDS is the seventh-leading cause of death in Americans between the ages of 15 and 24 and the fifth-leading cause of death among those 25 to 44 years old.

People who are or have been intravenous drug users, have had sex with an HIV-infected partner and men who have had sex with men after 1975 are among the groups at high risk for contracting HIV.

In addition, data from AHRQ's Healthcare Cost and Utilization Project indicate that, of approximately 4.7 million women who were hospitalized for pregnancy or childbirth in 2002, nearly 6,300 were infected with HIV.

The Task Force, which is supported by AHRQ, is the leading independent panel of private-sector experts in prevention and primary care. Its recommendations are considered the gold standard for clinical preventive services. It conducts rigorous, impartial assessments of the scientific evidence for a broad range of preventive services.

The Task Force grades the strength of its evidence from A (strongly recommends), B (recommends), C (no recommendation for or against), D (recommends against), or I (insufficient evidence to recommend for or against). The Task Force strongly recommends that clinicians screen all pregnant women for HIV (an A recommendation). The Task Force strongly recommends that clinicians screen all adolescents and adults at increased risk for HIV infection (an A recommendation). The Task Force makes no recommendation for or against routinely screening for HIV among adolescents and adults who are not at increased risk for HIV infection (a C recommendation).

Source: Agency for Healthcare Research and Quality (AHRQ)