Despite state laws requiring that every pregnant woman be offered HIV testing multiple times during pregnancy, about 20 percent of women reach their third trimester without it, according to a review of Florida women from 2003-04, researchers say.
Rapid HIV testing performed on 1,867 women who lacked proof of testing when they reached the delivery room identified one HIV-positive mother and doctors were able to preventively reduce the baby’s infection risk, says Dr. Andrew W. Helfgott, chief of the Section of Maternal-Fetal Medicine at the Medical College of Georgia.
“Rapid testing is an easy, relatively inexpensive means of identifying women who are infected, treating them and their babies and preventing perinatal infection,” says Dr. Helfgott.
Rapid testing of the 1,379 women cost $27,000, far less than the lifetime cost of treating even one infected child, he says.
Availability of the 20-minute, highly accurate tests that can be used even in the last minutes of pregnancy should preclude HIV infection in every newborn, he says. Still, an estimated 280 to 370 HIV-infected children are born each year in this country.
Dr. Helfgott was directing a high-risk pregnancy program in Pensacola, Fla., in 2002 when Florida led the nation with 37 perinatal transmissions, three of which occurred in the relatively small town where he worked. He started working with the Centers for Disease Control and Prevention and Florida Department of Health Bureau of HIV officials to focus attention on the importance of testing.
Florida laws were changed requiring women be offered testing in the first and third trimester and rapid testing if they lacked proof of HIV status in labor and delivery, Dr. Helfgott says. Since then, laws have been further strengthened in the panhandle state, making HIV a standard part of prenatal testing unless a woman opts out.
He presented some of the results Monday May 8 during The American College of Obstetricians and Gynecologists 54th annual meeting in Washington, D.C.
There is no law requiring testing in pregnancy in the state of Georgia despite the fact that an infected mother has a 25 percent chance of infecting her child, says Dr. Helfgott, who is working with state officials on raising awareness of the need for testing in his current home state.
Infection risk can be cut to less than 2 percent if an HIV-positive woman gets treatment during pregnancy, labor and delivery and the baby gets treatment in the first six weeks of life, he says. Even if treatment is given only to the baby within 48 hours of birth, risk is reduced to about 6 percent, Dr. Helfgott says.
“The problem we found in Pensacola is the women either didn’t get offered testing in the third trimester or - and this will remain a problem all over the country until we go totally to electronic medical records - we had trouble getting prenatal care records while women were in labor and delivery,” he says. Even when the doctor providing prenatal care delivers the child, records may not be quickly accessible, Dr. Helfgott says.
Greater awareness by health care providers of the need for testing coupled with the ability to quickly test women in labor, could achieve the goal of eliminating perinatal transmission, he says.
It appears to be working in Florida: the state reported one perinatal transmission for the fiscal year ending June 2005.
Revision date: June 14, 2011
Last revised: by Jorge P. Ribeiro, MD