A task force of the Agency for Healthcare Research and Quality (AHRQ; Rockville, Maryland) has issued a new recommendation suggesting that all pregnant women — not just those identified as at risk for contracting HIV — be screened for the infectious disease, which can be passed on to the baby during childbirth if mitigating procedures are not followed.
The U.S. Preventative Services Task Force issued the new recommendation on Monday, following what the task force's vice chair called a "very comprehensive systematic literature review," which found that HIV testing is virtually 100% accurate in laboratories.
The goal is to cut down on the risk for pregnant women giving birth and passing on the disease to their children, as well as to get treatment for the mother as soon as possible on an antiretroviral therapy program, such as HAART, which has been shown to slow the progression of the disease.
"The data suggests that asking women whether or not they're at risk does not necessarily work to identify all of those women who have HIV during pregnancy," task force Vice Chair Diana Petitti, MD, told Diagnostics & Imaging Week. Petitti also is senior scientific advisor for health policy and medicine for Kaiser Permanente in Southern California.
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 said it "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.
The goal is to make an HIV test an automatic part of any woman's pregnancy care.
"Right now, we have a variety of screening tests that are done during pregnancy, including tests for syphilis that are done universal[ly]," Petitti said. "Because it's easier to simply say, 'Let's test everyone,' given that the false positive rate is essentially zero, [let's] not try to make people or their physicians think about what they may or may not know."
The Centers for Disease Control and Prevention (CDC; Atlanta) in April of 2003 came out with a similar recommendation that all pregnant women be tested for HIV.
Since the U.S. Preventative Services Task Force does not have regulatory authority, Petitti said it is "uncertain what the impact will be" as a result of issuing the new recommendation but noted that its recommendations are "highly regarded by physicians."
Another goal that the task force has for the recommendation that all pregnant women be tested for HIV is that testing for such infections as HIV be "destigmatized." She noted that it has been a priority for the task force to offer its recommendation on HIV screening, since it had not provided any comment since 1996.
In that year, 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.
OraSure Technologies (Bethlehem, Pennsylvania), which provides rapid-screening products for HIV testing, supported the task force's recommendation. The company's products are used widely in emergency departments. OraSure became the first company in the U.S. to gain FDA approval for a rapid, point-of-care test designed to detect antibodies to HIV-1 within about 20 minutes in November 2002.
"We, of course, fully support" testing "pregnant moms" for HIV, Ronald Spair, executive vice president and CFO of OraSure, told D&IW.
Spair said the number of pregnant women who still do not receive prenatal care and "present at the hospital ER ready to give birth" is "frightening," particularly since most do not know what their HIV status is.
A Canadian provider of rapid HIV testing in the U.S. also supported the recommendation.
Giles Crouch, vice president of global sales and marketing for MedMira (Halifax, Nova Scotia), said, "The CDC gives one direction that's very useful, but you need more than one [recommendation]. It's sort of a second seal of approval for healthcare providers. Rapid testing in maternity settings is still quite new, and now the tests that are out there are proven reliable."
Among the courses of action that an ER physician can take with an HIV-positive mother about to deliver to prevent transmission is to perform a C-section and have the mother avoid breastfeeding. Also, the task force said that infected mothers who receive treatment can reduce the chance that their infants will be infected to as low as 1%, as opposed to 25% of infants born to HIV-positive mothers who aren't treated during pregnancy.
However, while rapid testing is needed for pregnant women of unknown HIV status about to deliver in an ER, Petitti said the best course of action for pregnant women is to receive prenatal care from a doctor and receive a "virtually 100% accurate" test in a typical hospital lab.