Screening HIV-positive pregnant women for antiretroviral therapy: utility of self-reported symptoms.
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.
Nguyen
Ruby Hn
RH
Epidemiology Branch, National Institute of Environmental Health Sciences/NIH, Research Triangle Park, NC 27709, USA. nguyen5@niehs.nih.gov
Gange
Stephen J
SJ
Serwadda
David
D
Kigozi
Godfrey
G
Kiwanuka
Noah
N
Sewankambo
Nelson K
NK
Wabwire-Mangen
Fred
F
Quinn
Thomas C
TC
Wawer
Maria
M
Gray
Ronald H
RH
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
D019380:Anti-HIV Agents