HIV Screening of Pregnant Women and Newborns (1991) / Chapter Skim
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4 Newborn Screening for HIV Infection
4 Newborn Screening for HIV Infection
Pages 25-32
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From page 25... ...
The following section presents the committee's assessment of and conclusions regarding whether the above goals could reasonably be achieved through neonatal HIV screening. Early Therapeutic Intervention for Asymptomatic HIV-lnfected Children The major goal of screening newborns for HIV infection is improvement, through early medical intervention, of the duration or quality of HIV-infected infants' lives.
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From page 26... ...
Both HIV p24 antigen tests and virus culture have been used to diagnose HIV infection in adults and children; however, their relative insensitivity In young infants makes them inappropriate for use as screening tools.2 Several other tests are under investigation (e.g., assays for IgM and IgA HIV antibodies, which do not cross the placenta tWeiblen et al., 1990~; in vitro HIV antibody production [Amadori et al., 1988~; polymerase chain reaction [Rogers et al., 19893) that may eventually be useful in the early diagnosis of HIV infection in infants, but these tests require more extensive development and evaluation before they are ready 1In May 1990?
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From page 27... ...
Many pediatric experts believe that, in the absence of known HIV infection, HIV-antibody-positive infants should not receive antiretroviral therapy or PCP prophylaxis as a matter of course. These therapies are not without toxicity, and prescribing them for all seropositive infants means that uninfected children would be exposed to substantial toxicity without deriving any medical benefits.
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From page 28... ...
Nevertheless, the committee encourages providers and medical centers to develop an aggressive primary care system for all infants at increased risk of adverse health outcomes. The committee also opposes newborn HIV screening because it is tantamount to involuntary maternal screening in that testing newborns for HIV antibodies reveals their mothers' infection status.
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From page 29... ...
This approach provides unbiased epidemiological data for monitoring national and local trends in the distribution of HIV infection, particularly among childbearing women. These data are also useful in planning and evaluating public health interventions, targeting community outreach and prevention campaigns, and anticipating health care resource needs.
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From page 30... ...
A valid, reliable screening test would make the requirements for therapeutic efficacy less stringent because the risk of exposing uninfected infants to potentially toxic therapy would be diminished. For instance, even if available drug therapy proved only moderately effective, voluntary newborn HIV screening (with specific informed consent from the parent or legal guardian)
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From page 31... ...
Finally, decisions regarding initiation of therapy should take into account the heterogeneity of the clinical course of HIV disease in perinatally infected infants-for instance, most infants will develop symptoms within the first year or two of life, whereas some will remain Symptomatic for a number of years.
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