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Ann Intern Med. 2012 Nov 20;157(10):719-28. doi: 10.7326/0003-4819-157-10-201211200-00009.

Screening for HIV in pregnant women: systematic review to update the 2005 U.S. Preventive Services Task Force recommendation.

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1
Oregon Health & Science University, 3181 Southwest Sam Jackson Park Road, Mail Code BICC, Portland, OR 97239, USA. chour@ohsu.edu

Abstract

BACKGROUND:

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 for mother-to-child transmission.

PURPOSE:

To update the 2005 USPSTF review, focusing on previously identified research gaps and new evidence on treatments.

DATA SOURCES:

MEDLINE (2004 to June 2012) and the Cochrane Library (2005 to the second quarter of 2012).

STUDY SELECTION:

Randomized trials and cohort studies of pregnant women on risk for mother-to-child transmission or harms associated with prenatal HIV screening or antiretroviral therapy during pregnancy.

DATA EXTRACTION:

2 reviewers abstracted and confirmed study details and quality by using predefined criteria.

DATA SYNTHESIS:

No studies directly evaluated effects of prenatal HIV screening on risk for mother-to-child transmission or maternal or infant clinical outcomes. One fair-quality, large cohort study (HIV prevalence, 0.7%) found that rapid testing during labor was associated with a positive predictive value of 90%. New cohort studies of nonbreastfeeding women in the United States and Europe confirm that full-course combination antiretroviral therapy reduces rates 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 to be associated with increased risk for preterm delivery (<37 weeks' gestation); there were no clear associations with low birthweight, congenital abnormalities, or infant neurodevelopment. Evidence on long-term maternal harms after short-term antiretroviral therapy exposure during pregnancy remains sparse.

LIMITATIONS:

Only English-language articles were included. Studies conducted in resource-poor settings may be of limited applicability to screening in the United States.

CONCLUSION:

Antiretroviral therapy in combination with avoidance of breastfeeding and elective cesarean section in women with viremia reduces risk for mother-to-child transmission. Use of certain antiretroviral therapy regimens during pregnancy may increase risk for preterm delivery.

PRIMARY FUNDING SOURCE:

Agency for Healthcare Research and Quality.

[Indexed for MEDLINE]
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