Frequent detection of acute HIV infection in pregnant women.
BACKGROUND
Universal prenatal HIV antibody testing, which does not detect acute HIV, is standard for pregnant women in the United States. Unrecognized HIV acquisition during pregnancy may result in higher rates of perinatal transmission.


OBJECTIVE
To determine the prevalence of acute (antibody-negative) HIV infection in pregnant women and to assess the potential for prompt initiation of antiretroviral therapy to prevent perinatal transmission.


METHODS
From 1 November 2002 to 30 April 2005, all publicly funded HIV testing sites participated in North Carolina's Screening and Tracing Active Transmission (STAT) Program, which retested all specimens that were HIV antibody negative for HIV RNA using specimen pooling. All patients with acute HIV infection were immediately traced for evaluation, confirmatory testing, counseling, and referral services. For this study, all pregnant women with acute HIV were immediately initiated onto antiretroviral therapy and followed prospectively for pregnancy outcomes.


RESULTS
During the study period, 443 women were HIV positive by antibody testing; 15 were HIV antibody negative but positive by RNA assay and of these five were pregnant at the time of testing. The pregnant women received antiretroviral drugs and delivered HIV-uninfected infants. Maternal testing records of all six HIV-infected infants born in North Carolina showed three mothers with chronic HIV infection and three HIV antibody negative at private prenatal testing facilities.


CONCLUSIONS
In resource-rich settings, a substantial proportion of residual perinatal transmission may be from HIV acquisition during pregnancy. Standard antibody tests miss acute HIV infection and so algorithms that include pooled HIV RNA testing may improve its detection and represent a further opportunity to prevent perinatal transmission.
Patterson
Kristine B
KB
School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. Kristine_patterson@med.unc.edu
Leone
Peter A
PA
Fiscus
Susan A
SA
Kuruc
Joann
J
McCoy
Sandra I
SI
Wolf
Leslie
L
Foust
Evelyn
E
Williams
Del
D
Eron
Joseph J
JJ
Pilcher
Christopher D
CD
D000208:Acute Disease; D000465:Algorithms; D019380:Anti-HIV Agents / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006678:HIV / Q000235:genetics; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000635:transmission; D006679:HIV Seropositivity / Q000175:diagnosis; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D008403:Mass Screening / Q000379:methods; D009657:North Carolina; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000188:drug therapy; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D011295:Prenatal Care / Q000379:methods; D015995:Prevalence; D012367:RNA, Viral / Q000097:blood*; D015215:Zidovudine / Q000627:therapeutic use
D019380:Anti-HIV Agents; D012367:RNA, Viral; D015215:Zidovudine