title: Screening HIV-positive pregnant women for antiretroviral therapy: utility of self-reported symptoms.
abstract: In developing countries, Mother-to-Child Transmission-Plus programmes propose to identify lifelong antiretroviral therapy (ART)-eligible women during antenatal care. Identification using AIDS-related symptoms is the most feasible screening procedure in resource-limited settings. It is not known if symptomatology in pregnant women is correlated with clinical criteria for ART initiation based on CD(4)+ cell count or HIV-1 viral load. In this population of HIV-positive pregnant women from Rakai District, Uganda, 8-23% were eligible for treatment by CD(4)+ cell count criteria, and <1% met WHO staging criteria for AIDS. Using one or more symptoms to predict CD(4)+ cell count <350 cells/mm(3), sensitivity was 100%, specificity 11%, positive predictive value (PPV) 25%, and negative predictive value (NPV) 100%. When using one or more symptoms to predict viral load > or =100,000 cps/mL, sensitivity was 100%, specificity 10%, PPV 6%, and NPV 100%. Initiation of treatment based on self-reported symptoms will over-treat because the majority of pregnant women with symptoms would not be eligible for treatment under current guidelines, but asymptomatic pregnant women are unlikely to require ART.
authors.affiliation: Epidemiology Branch, National Institute of Environmental Health Sciences/NIH, Research Triangle Park, NC 27709, USA. nguyen5@niehs.nih.gov
authors.forename: Ruby Hn
authors.initials: RH
authors.lastname: Nguyen
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Gange
authors.forename: David
authors.initials: D
authors.lastname: Serwadda
authors.forename: Godfrey
authors.initials: G
authors.lastname: Kigozi
authors.forename: Noah
authors.initials: N
authors.lastname: Kiwanuka
authors.forename: Nelson K
authors.initials: NK
authors.lastname: Sewankambo
authors.forename: Fred
authors.initials: F
authors.lastname: Wabwire-Mangen
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Quinn
authors.forename: Maria
authors.initials: M
authors.lastname: Wawer
authors.forename: Ronald H
authors.initials: RH
authors.lastname: Gray
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000592:standards*; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology*; D006679:HIV Seropositivity; D006801:Humans; D008403:Mass Screening / Q000191:economics / Q000379:methods*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy; D037841:Pregnant People; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents