Friday, January 25, 2008

Haitians, Pregnancy, and HIV...What can be Done? Alot.

Please see the article below. This article is not addressing the pregnant patient with obvious HIV. This article is about ACUTE HIV in pregnant women and what can be done about it.

Rates of perinatal tranmission of HIV in the United States have decreased from >25% before 1994 to <2% in 2006. This is due to the use of maternal antiretroviral treatment and infant prophylaxis.

The HIV scourge for Haitian newborns could be diminished dramatically with better effort to screen their mothers.

Detecting Acute HIV Infection During Pregnancy

Five pregnant women with acute HIV infection were identified at publicly funded testing sites in North Carolina and subsequently treated; none transmitted HIV to their infants.

Prevention of mother-to-child HIV transmission has been a major success in the U.S. However, a small number of infants still are born infected in this country each year. To address this problem, the CDC has renewed its efforts to ensure that all pregnant women are tested for HIV antibodies (ACC Oct 6 2006), but, even if this strategy is fully implemented, cases of acute HIV infection will still be missed. Now, researchers describe the detection of acute HIV infection among pregnant women in North Carolina, where nucleic-acid amplification testing was added to standard antibody testing at publicly funded sites in 2002 (for more details on this testing strategy, see ACC May 11 2005).

From November 2002 through April 2005, 187,135 women were tested for HIV at such sites. Of these women, 443 (0.2%) were found to be HIV infected; most were black and were probably infected heterosexually. Fifteen of the women had acute HIV infection (i.e., were HIV-antibody negative but HIV-RNA positive) at the time of testing, including 5 who were pregnant (median, 15 weeks’ gestation; median viral load, 88,787 copies/mL). Antiretroviral therapy was prescribed for all five women within 14 days of diagnosis. Four of the women were adherent and had viral loads <400 copies/mL at delivery; the other woman had a viral load >40,000 copies/mL at delivery, necessitating a cesarean section. None of the infants tested positive for HIV DNA during the first 4 to 6 months of life.

Comment: In this study, 3.4% of women with newly diagnosed HIV infection were acutely infected, and one third of these women were pregnant at the time of diagnosis. The cost of adding HIV RNA testing to antibody testing was minimal: $3.63 per specimen tested. North Carolina has taken the lead in implementing a new approach to HIV testing that has proven to be effective. Isn’t it time for all states to start doing the same thing?

— Carlos del Rio, MD

Published in AIDS Clinical Care January 18, 2008

Patterson KB et al. Frequent detection of acute HIV infection in pregnant women. AIDS 2007 Nov; 21:2303.

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