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Prenatal HIV tests urged for all women

By LISA M. KRIEGER
Knight Ridder Newspapers
Posted on Thu, Jul. 07, 2005

SAN JOSE, Calif. — An influential panel of American health experts is urging that all pregnant women be tested for the AIDS virus, an ambitious approach that aims to further reduce the number of HIV-infected babies.

The U.S. Preventive Services Task Force says the current strategy of offering tests only to “high risk” women misses many opportunities to save babies.

Although the doctors’ advice is not binding, it is likely to influence medical policy. It echoes earlier recommendations by the federal Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecologists — creating widespread consensus in the field.

“An HIV test is looked at, more and more, just like any other test that one would recommend at a time of prenatal care, with very few risks and many benefits,” said Dr. Diana Petitti, vice chairwoman of the task force.

About 300 infants are born infected in the United States each year — and as many as 40 percent, or 120, are born to mothers who did not know they were HIV positive before delivery.

“We should offer the test to all pregnant women — and allow them the chance to say yes or no,” Petitti said. “It is better to know than not to know. You can’t solve a problem you don’t know about.”

If more maternal infections are detected early, doctors can take steps to help prevent transmission to newborns, the panel concluded. Its recommendation was published in the Annals of Internal Medicine.

In pregnant women, early identification of HIV infection allows treatment to prevent the spread of infection.

Without the mother’s treatment, a baby has a one in four chance of becoming infected. This risk can be reduced to fewer than one in 20 if women stay healthy, participate in prenatal care, take anti-AIDS medications and bottle-feed instead of breast-feed.

At-risk babies also get medication after birth to fend off infection.

The CDC reported in June that the highest rate of HIV infection in the country occurs among bisexual black men. And because men are reluctant to disclose gay sex to their female partners, this has implications for unprotected women — and their children. Black women are 19 times more likely to be infected than white women.

The physician panel recommends only voluntary, not mandatory, testing. Some nations, such as Ireland and Australia, are considering mandatory testing.

HIV tests no longer carry the stigma they once did and might be less frightening to women, according to Petitti.

“HIV has evolved into a more chronic manageable illness, rather than a death sentence it seemed to be in the ’80s and ’90s, because of the availability of therapy,” she said.

Testing of pregnant women could change perception in the public’s mind, Petitti said.

“Maybe the test will become less controversial and more routine,” said Petitti, who is also a scientific adviser for Health Policy and Medicine for Kaiser Permanente-Southern California in Pasadena.

In reviewing its previous position, the task force considered growing evidence that intervention can save babies.

“I think it’s pretty amazing — and really one of the miracles of medicine — that the risk of transmission now can be reduced to well below 5 percent,” Petitti said.