Number Of Children With AIDS Still Unacceptably High; Routine HIV TestingNeeded In Prenatal Care

October 14, 1998

WASHINGTON -- Testing for the human immunodeficiency virus (HIV) should be a routine part of prenatal care, according to a new report from a committee of the Institute of Medicine. Health care providers should notify women that HIV testing is part of the usual array of prenatal tests and women should have an opportunity to refuse. This approach could help reduce the number of pediatric AIDS cases and improve treatment for mothers with AIDS.

Current federal guidelines were put in place after discovery in 1994 of a new therapy that reduces by two-thirds the chance that an infected woman will pass HIV to her child. The guidelines advise health care providers to give extensive pre-test counseling to all pregnant women, educating them about the risks of AIDS and the benefits of being tested. These guidelines led to an increase in testing and treatment. But because many women are not tested and do not receive treatment, the number of children born with HIV is still unacceptably high, the report says.

"We have the tools to prevent HIV infection in newborns. Now we must get treatment to everyone who needs it," said committee chair Marie McCormick, professor and chair, department of maternal and child health, Harvard School of Public Health, Boston. "By making HIV screening a routine part of prenatal care for all pregnant women, regardless of their risk factors or where they live, we can further lower the number of pediatric AIDS cases and help infected women get high-quality treatment."

Making prenatal testing routine would help lower many of the barriers that keep women from being tested. It would reduce the burden on prenatal care givers to provide the extensive pre-test counseling required by current guidelines. Providers would no longer have to decide whether to encourage some women more than others to be tested, an approach that results in many cases being missed. It would lessen the stigmatization of groups in which perinatal HIV transmission is now more prevalent, which include African American and Hispanic women. And it would guard against geographic shifts in the incidence of HIV infection, which is more common among women in large cities and in parts of the northeastern and southern United States. The costs of routine prenatal testing compare favorably with the costs of treating children who have HIV.

The committee outlined a series of steps to support routine testing in prenatal care, and to meet the needs of pregnant women and health care providers. Health care plans should implement policies to facilitate routine prenatal testing, and should track their success in conducting HIV screening. Businesses and other organizations that purchase health care should support routine prenatal testing in their contracts with providers. Professional medical organizations should update their practice guidelines to recommend such testing. Providers need to be educated about the value of prenatal HIV screening, and how to deal appropriately with those who test positive. And health officials need to improve their outreach to pregnant women, to address concerns about testing and treatment.

Testing should be seamlessly linked to treatment for women found to be infected, and this care must be coordinated before, during, and after delivery, the report says. Providers must take steps, however, to ensure that their patient's confidentiality is protected, and that they are not forced into taking a test if they object.

EFFECTIVE TREATMENT

Researchers determined in 1994 that administering the drug zidovudine (ZDV, formerly known as AZT) during pregnancy and childbirth could reduce by two-thirds the chance that a mother infected with HIV would give birth to an infected child. The finding was one of the most important since the beginning of the AIDS epidemic, because 6,000 to 7,000 HIV-infected women in the United States give birth each year.

After the initial research findings were announced in 1994, federal agencies, most states, and a number of professional organizations instituted policies, legislation, and guidelines to encourage HIV testing for pregnant women. As a result of ZDV treatment and other factors, the number of new pediatric AIDS cases dropped by about 43 percent between 1992 and 1996.

It is critical that federal funding for state and local efforts to prevent perinatal HIV transmission be maintained, the report says. The committee was not asked to take a position on mandatory testing of all newborns, but noted that such testing can only play a limited role in preventing transmission of HIV from mother to child. Under the current provisions of the Ryan White Comprehensive AIDS Resources Emergency Act Amendments of 1996, federal funds for states could become contingent upon mandatory testing of newborns. If funds that could be used for prevention are directed toward newborn testing, the federal government could actually undermine efforts to keep infants from contracting the virus.

To boost prevention efforts, the federal government should establish a regional system of perinatal HIV prevention and treatment centers. These centers would help assure optimal HIV care for all pregnant women and newborns, and would help develop and implement strategies to improve HIV testing in prenatal care. Federal, state, and local public health agencies also should maintain appropriate surveillance data on HIV-infected women and children, the report says.

This study was funded by the U.S. Department of Health and Human Services. The Institute of Medicine is a private, non-profit organization that provides health policy advice under a congressional charter granted to the National Academy of Sciences.

Pre-publication copies of REDUCING THE ODDS: PREVENTING PERINATAL TRANSMISSION OF HIV IN THE UNITED STATES are available from the National Academy Press at the mailing address in the letterhead; tel. (202) 334-3313 or 1-800-624-6242. The cost of the report is $48.95 (prepaid) plus shipping charges of $4.00 for the first copy and $.50 for each additional copy. Reporters may obtain a copy from the Office of News and Public Information.
-end-


National Academies of Sciences, Engineering, and Medicine

Related HIV Articles from Brightsurf:

BEAT-HIV Delaney collaboratory issues recommendations measuring persistent HIV reservoirs
Spearheaded by Wistar scientists, top worldwide HIV researchers from the BEAT-HIV Martin Delaney Collaboratory to Cure HIV-1 Infection by Combination Immunotherapy (BEAT-HIV Collaboratory) compiled the first comprehensive set of recommendations on how to best measure the size of persistent HIV reservoirs during cure-directed clinical studies.

The Lancet HIV: Study suggests a second patient has been cured of HIV
A study of the second HIV patient to undergo successful stem cell transplantation from donors with a HIV-resistant gene, finds that there was no active viral infection in the patient's blood 30 months after they stopped anti-retroviral therapy, according to a case report published in The Lancet HIV journal and presented at CROI (Conference on Retroviruses and Opportunistic Infections).

Children with HIV score below HIV-negative peers in cognitive, motor function tests
Children who acquired HIV in utero or during birth or breastfeeding did not perform as well as their peers who do not have HIV on tests measuring cognitive ability, motor function and attention, according to a report published online today in Clinical Infectious Diseases.

Efforts to end the HIV epidemic must not ignore people already living with HIV
Efforts to prevent new HIV transmissions in the US must be accompanied by addressing HIV-associated comorbidities to improve the health of people already living with HIV, NIH experts assert in the third of a series of JAMA commentaries.

The Lancet HIV: Severe anti-LGBT legislations associated with lower testing and awareness of HIV in African countries
This first systematic review to investigate HIV testing, treatment and viral suppression in men who have sex with men in Africa finds that among the most recent studies (conducted after 2011) only half of men have been tested for HIV in the past 12 months.

The Lancet HIV: Tenfold increase in number of adolescents on HIV treatment in South Africa since 2010, but many still untreated
A new study of more than 700,000 one to 19-year olds being treated for HIV infection suggests a ten-fold increase in the number of adolescents aged 15 to 19 receiving HIV treatment in South Africa, according to results published in The Lancet HIV journal.

Starting HIV treatment in ERs may be key to ending HIV spread worldwide
In a follow-up study conducted in South Africa, Johns Hopkins Medicine researchers say they have evidence that hospital emergency departments (EDs) worldwide may be key strategic settings for curbing the spread of HIV infections in hard-to-reach populations if the EDs jump-start treatment and case management as well as diagnosis of the disease.

NIH HIV experts prioritize research to achieve sustained ART-free HIV remission
Achieving sustained remission of HIV without life-long antiretroviral therapy (ART) is a top HIV research priority, according to a new commentary in JAMA by experts at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.

The Lancet HIV: PrEP implementation is associated with a rapid decline in new HIV infections
Study from Australia is the first to evaluate a population-level roll-out of pre-exposure prophylaxis (PrEP) in men who have sex with men.

Researchers date 'hibernating' HIV strains, advancing BC's leadership in HIV cure research
Researchers have developed a novel way for dating 'hibernating' HIV strains, in an advancement for HIV cure research.

Read More: HIV News and HIV Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.