Prenatal screening for HIV: A review of the evidence for the U.S. Preventive Services Task Force.
BACKGROUND
Each year in the United States, 6000 to 7000 women with HIV give birth. The management and outcomes of prenatal HIV infection have changed substantially since the U.S. Preventive Services Task Force issued recommendations in 1996.


OBJECTIVE
To synthesize current evidence on risks and benefits of prenatal screening for HIV infection.


METHODS
MEDLINE, the Cochrane Library, reference lists, and experts.


METHODS
Studies of screening, risk factor assessment, accuracy of testing, follow-up testing, and efficacy of interventions.


METHODS
Data on settings, patients, interventions, and outcomes were abstracted for included studies; quality was graded according to criteria developed by the Task Force.


RESULTS
No published studies directly link prenatal screening for HIV with clinical outcomes. In developed countries, the rate of mother-to-child transmission from untreated HIV-infected women is 14% to 25%. Targeted screening based on risk factors would miss a substantial proportion of infected women. "Opt-out" testing policies appear to increase uptake rates. Standard HIV testing is highly (>99%) sensitive and specific, and initial studies of rapid HIV tests found that both types of testing had similar accuracy. Rapid testing can facilitate timely interventions in persons testing positive. Recommended interventions (combination antiretroviral regimens, elective cesarean section in selected patients, and avoidance of breastfeeding) are associated with transmission rates of 1% to 2% and appear acceptable to pregnant women.


CONCLUSIONS
Long-term safety data for antiretroviral agents are not yet available. Data are insufficient to accurately estimate the benefits of screening on long-term maternal disease progression or other clinical outcomes, such as horizontal transmission.


CONCLUSIONS
Identification and treatment of asymptomatic HIV infection in pregnant women can greatly decrease mother-to-child transmission rates.
Oregon Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon 97239, USA. chour@ohsu.edu
Roger
R
Chou
Ariel K
AK
Smits
Laurie Hoyt
LH
Huffman
Rongwei
R
Fu
P Todd
PT
Korthuis
D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D005260:Female; D015483:HIV Antibodies / Q000032:analysis; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000635:transmission; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008403:Mass Screening / Q000379:methods; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D011296:Prenatal Diagnosis / Q000379:methods; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
D044966:Anti-Retroviral Agents; D015483:HIV Antibodies