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Cover of Screening for HIV in Pregnant Women: Systematic Review to Update the U.S. Preventive Services Task Force Recommendation

Screening for HIV in Pregnant Women: Systematic Review to Update the U.S. Preventive Services Task Force Recommendation

Evidence Syntheses, No. 96

Investigators: , MD, , MD, MPH, , MPH, and , MBBS.

Oregon Evidence-based Practice Center, Oregon Health & Science University
Rockville (MD): Agency for Healthcare Research and Quality (US); .
Report No.: 12-05173-EF-2

Structured Abstract


A 2005 U.S. Preventive Services Task Force (USPSTF) review found good evidence that prenatal HIV screening is accurate and can lead to interventions that reduce the risk of mother-to-child transmission.


To systematically update the 2005 USPSTF review on benefits and harms of prenatal HIV screening, focusing on research gaps previously identified and new evidence on treatments.

Data Sources:

We searched MEDLINE (2004 to June 2012) and the Cochrane Library Database (2005 to the second quarter of 2012) and manually reviewed reference lists.

Study Selection:

We selected randomized trials and cohort studies of pregnant women that reported risk of mother-to-child transmission or maternal or infant harms associated with prenatal HIV screening or antiretroviral therapy during pregnancy. We also selected studies that reported the yield of repeat prenatal screening or the positive predictive values and harms associated with rapid versus standard HIV testing during pregnancy.

Data Extraction:

Two reviewers abstracted and confirmed study details and quality using predefined criteria, based on methods developed by the USPSTF.

Data Synthesis (Results):

No study directly evaluated effects of prenatal screening for HIV infection versus no screening on risk of mother-to-child transmission or maternal or infant clinical outcomes. One fair-quality, large cohort study (0.7% HIV prevalence) found rapid testing during labor associated with a positive predictive value of 90 percent. New cohort studies of nonbreastfeeding women in the United States and Europe confirm that full-course combination antiretroviral therapy reduces risk of mother-to-child transmission (<1% to 2.4% vs. 9% to 22% with no antiretroviral therapy). New cohort studies found antiretroviral therapy during pregnancy associated with increased risk of preterm (prior to 37 weeks’ gestation) delivery, with no clear association with low birth weight, congenital abnormalities, or infant neurodevelopment.

Although some studies found an association between in utero exposure to antiretroviral therapy and subsequent echocardiographic abnormalities, hematologic abnormalities, and markers of mitochondrial dysfunction, the clinical significance of these findings remains unclear. Evidence on long-term maternal harms associated with short-term exposure to antiretroviral therapy during pregnancy, or antiretroviral therapy started during pregnancy and continued after pregnancy, remains sparse.


Only English-language articles were included. Due to limited evidence from randomized trials, we included cohort studies of treatments. Studies conducted in resource-poor settings may be of limited applicability to screening in the United States.


Antiretroviral therapy in combination with avoidance of breastfeeding and elective Cesarean delivery in women with viremia reduces risk of mother-to-child transmission. Use of certain antiretroviral therapy regimens during pregnancy may increase risk of preterm delivery, but more evidence is needed to fully understand short- and long-term maternal and infant effects.


Acknowledgements: The authors acknowledge Tracy Dana, MLS, for conducting literature searches, and Ian Blazina, MPH, and Laurie Hoyt Huffman, MS, for contributions to the report. The authors also thank AHRQ Medical Officer Jennifer Croswell, MD, MPH, as well as the U.S. Preventive Services Task Force Leads, Susan Curry, PhD, Virginia Moyer, MD, MPH, Wanda Nicholson, MD, MPH, MBA, and Timothy Wilt, MD, MPH.

Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services1, Contract No. HHSA-290-2007-10057-I, Task Order No. 8, Prepared by: Oregon Evidence-based Practice Center, Oregon Health & Science University2

Suggested citation:

Chou R, Cantor A, Bougatsos C, Zakher B. Screening for HIV in Pregnant Women: Systematic Review to Update the U.S. Preventive Services Task Force Recommendation. Evidence Synthesis No. 96. AHRQ Publication No. 12-05173-EF-2. Rockville, MD: Agency for Healthcare Research and Quality; November 2012.

This report is based on research conducted by the Oregon Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-02-0024). The investigators involved have declared no conflicts of interest with objectively conducting this research. The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

The information in this report is intended to help clinicians, employers, policymakers, and others make informed decisions about the provision of health care services. This report is intended as a reference and not as a substitute for clinical judgment.

The report may be used, in whole or in part, as the basis for the development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.


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Bookshelf ID: NBK114880PMID: 23256219


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