Authors' objectives:

This report aims to synthesize the evidence on risks and benefits of screening for HIV infection in pregnant women.

Authors' results and conclusions: There are no published trials directly linking screening for HIV in pregnant women with clinical outcomes. In developed countries, the rate of mother-to-child transmission from untreated HIV-infected women ranges from 14% to 25%. Targeted screening of pregnant women with risk factor assessment would miss a significant proportion of infected persons. Standard office-based testing is highly (>99%) sensitive and specific, and initial studies of rapid HIV tests in labor and delivery settings found similar diagnostic accuracy. Rapid testing may facilitate timely interventions in those testing positive. HIV testing rates during pregnancy continue to vary widely in the U.S. and appear to be higher in states using opt-out testing policies. Recommended interventions (combination antiretrovirals, elective cesarean section in selected patients, and avoidance of breastfeeding) are associated with transmission rates of 1%-2% in clinical trials and large observational studies. Shorter regimens are less effective, but also decrease the rate of transmission. Currently recommended combination antiretroviral regimens appear safe, but long-term follow-up is not yet available. Elective cesarean section is associated with an increased risk of mostly short-term adverse events. There are insufficient data to estimate the effects of interventions during pregnancy on long-term maternal outcomes.

Authors' recommendations: Identification and treatment of asymptomatic HIV infection in pregnant women can result in major reductions in mother-to-child transmission rates. The estimated benefits from combination antiretrovirals appear to greatly outweigh the risk of short-term complications. In settings with a maternal prevalence of 0.15%, the estimated number needed to screen to prevent one case of maternal-to-child transmission using conservative estimates of intervention effectiveness ranged from 3,500 to 12,170, and in settings with a maternal prevalence of 5%, ranged from 105 to 365. Data are insufficient to accurately estimate the long-term benefits of screening on maternal disease progression or other clinical outcomes (such as horizontal transmission).

Authors' methods: Review

Project Status: Completed

URL for project: http://www.ahrq.gov/clinic/uspstf/uspshivi.htm

Year Published: 2005

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: Agency for Healthcare Research and Quality

Contact Address: Center for Outcomes and Evidence Technology Assessment Program, 540 Gaither Road, Rockville, MD 20850, USA. Tel: +1 301 427 1610; Fax: +1 301 427 1639;

Contact Name: martin.erlichman@ahrq.hhs.gov

Contact Email: martin.erlichman@ahrq.hhs.gov

Copyright: Agency for Healthcare Research and Quality (AHRQ)