HIV Screening of Pregnant Women and Newborns (1991) / Chapter Skim
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5 Prenatal Screening for HIV Infection
5 Prenatal Screening for HIV Infection
Pages 33-42
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From page 33... ...
Effects on Vertical REV Transmission Preventing vertical transmission of HIV infection from mother to infant appears to be a desirable objective of prenatal HIV screening. Yet the limited studies to date offer little evidence to suggest that knowledge of HIV infection status significantly affects women's decisions regarding continuation of a pregnancy or future childbearing (Barbacci et al., 1989b; Kaplan et al., 1989; Schneck et al., 1989; Selwyn et al., 1989a; Johnstone et al., 1990; Sunderland, 1990~.
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From page 34... ...
Effects on Horizontal HIV Transmission Screening pregnant women for HIV infection may play a role in decreasing horizontal transmission of HIV to their partners. Yet here again the connection between an awareness of HIV infection status and behavioral change is unclear, in part because of insufficient data from which to draw conclusions about this relation.
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From page 35... ...
As more information accumulates regarding the effect of pregnancy on maternal disease progression and the impact of HIV infection on pregnancy outcome, learning of one's infection may become increasingly important for women facing reproductive decisions. Early Diagnosis of HIV Infection and Therapeutic Intervention During Pregnancy Another goal of screening pregnant women for HIV infection is to afford them an opportunity for early diagnosis, subsequent medical monitoring, and therapeutic intervention.
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From page 36... ...
Many obstetrical experts contend that the standard of care for HIV-infected nonpregnant adults should also apply to HIV-infected pregnant women, based on careful monitoring of immunologic function through serial CD4+ cell counts. Asymptomatic nonpregnant adults with CD4+ cell counts of 200 or less are at significantly greater risk of Pneumoc ystis pneumonia than those with higher counts; the presence independently of thrush or persistent fever enhances this risk (CDC, 1989b; Phair et al., 1990~.
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From page 37... ...
Concern for potential fetal toxicity has not been absent from discussions of appropriate management and treatment of HIV-infected pregnant women. To date, there are insufficient data on zidovudine therapy dunog pregnancy to draw conclusions about short-term fetal toxicity or adverse pregnancy outcomes related to such therapy.
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From page 38... ...
Additional Benefits of Prenatal HIV Screening In addition to the maternal benefits that may be derived from identification of HIV infection during pregnancy, there are potential collateral benefits for the infant. For instance, infants born to mothers who are known to be HIV infected could be closely followed from birth for evidence of immunologic impairment and other signs and symptoms of HIV infection, so that appropriate treatment can be administered when it is clinically indicated.
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From page 39... ...
during pregnancy on maternal disease progression and pregnancy outcome, as well as the impact of antiretroviral therapy on perinatal transmission.s Universal Versus Selective Prenatal HIV Screening The committee, having concluded that the advantages associated with early detection of HIV infection and medical intervention provide the most compelling argument for screening pregnant women, then considered whether screening should be ~universal" or "selectiven; that is, should all pregnant women within a particular geographic area be offered HIV testing (universals screening) , or should testing be offered only to a subset of pregnant women defined by self-acknowledged HIV risk behaviors, based on prior risk assessment (~selective" screening)
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From page 40... ...
Women who receive no prenatal care or who have not had an opportunity to be tested prior to delivery should be offered HIV testing at the time of labor and delivery or during the postpartum period. Additionally, in areas where prevalence levels may not warrant prenatal screening of all pregnant women at this time, health care providers should continue to offer voluntary HIV testing to pregnant women who have identified risk factors for HIV infection, in accordance 6High-prevalence areas are defined in Chapter 6.
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From page 41... ...
The committee recognizes the profound psychological and social ramifications that a diagnosis of HIV infection can have for an individual. Nevertheless, it believes that the benefits that have been shown to result from early diagnosis of infection and subsequent treatment counterbalance the potential risks.
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