HIV screening in pregnant women.

ABSTRACT

Abstract. The following recommendations are made for prenatal screening for HIV infection 1) Routine voluntary screening for HIV infection in all pregnant women is feasible and worthwhile. 2) Every seropositive result should be repeated for confirmation before coming to a definititve conclusion to avoid a misdiagnosis. 3) Fetal blood sampling in the mid-trimester for PCR and p24 antigen assay seems inappropriate as a diagnostic tool for in utero HIV infection of the HIV seropositive pregnant women as the infection mostly occurs after this time. 4) Routine screening of seronegative pregnant women should be repeated during the third trimester to detect seroconversion since this offers a chance for antiretroviral administration to the seroconverted pregnant women for reduction of perinatal transmission. 5) There should be available the appropriate back up services for seropositive pregnant women. There is sufficient evidence indicating a higher vertical HIV-1 transmission rate in the last trimester and during labour compared with the first and second trimesters. Antiretroviral therapy either single or in combination given to the mother during the last trimester and delivery can reduce the viral load in the maternal circulation. Vertical HIV-1 transmission during delivery can be minimized by appropriate timing and route of delivery. Elective Cesarean section before the onset of labour with an intact bag of forewaters provides the least mother-to-fetus microtransfusion compared to other modes of delivery. Since an effective combination of HIV-1 immunoglobulin and HIV-1 vaccine given to the HIV-1 exposed newborns to prevent HIV-1 transmission similar to the viral hepatitis B model is not firmly established at present, postexposure antiretroviral prophylaxis and nonbreast-feeding are advocated for infants born from the HIV-1 infected mothers. In cases of advanced stage of maternal HIV-1 infection, and in developing areas where malnutrition prevails, an adequate supply of essential micronutrients is proposed as an adjunctive measure to reduce HIV-1 perinatal transmission.