PEDIATRICS Vol. 104 No. 1 July 1999, pp. 128
AMERICAN ACADEMY OF PEDIATRICS:
Human Immunodeficiency Virus Screening
The problem of perinatal transmission of human
immunodeficiency virus (HIV) infection was first appreciated in 1982. In 1991, the Institute of Medicine (IOM) recommended a policy of
routine counseling and offering testing (with specific informed
consent) for HIV infection to all pregnant women. Since 1991, there
have been major advances in the treatment of HIV infection, including demonstration in 1994 of the efficacy of zidovudine to reduce perinatal
transmission. The US Public Health Service subsequently issued
guidelines for use of zidovudine to reduce perinatal transmission and
for counseling and voluntary testing for pregnant women. Dramatic declines in reported pediatric acquired immunodeficiency syndrome (AIDS) cases have been observed as a consequence of implementation of
these guidelines. However, for a variety of reasons, screening pregnant
women in the United States has been far from universal and infected
infants continue to be born to undiagnosed infected women. Further
reduction in the rate of perinatal HIV infection will require wider
application of both screening to identify infected women, and
treatments that have demonstrated efficacy in reducing vertical
transmission.
The IOM recently completed a study of interventions that would be
helpful to further reduce the rate of perinatal HIV infection in the
United States (Reducing the Odds). They have recommended that "the United States adopt a national policy of universal HIV testing, with patient notification, as a routine component of prenatal
care." Early diagnosis of HIV infection in pregnant women allows them
to institute effective antiretroviral therapy for their own health and
to reduce the risk of HIV transmission to their infants. The use of
"patient notification" provides women the opportunity to decline to
be tested but eliminates the obligation to provide extensive pretest
counseling, which has been a barrier to testing in many settings. Care
providers would be charged with responsibility for the details of how
the notification would take place. The IOM has recommended universal
testing for two reasons. First, attempts to identify those "at
risk" for infection inevitably fail to identify some infected
individuals. Second, universal testing of all pregnant women avoids
stereotyping and stigmatizing any social or ethnic group. The IOM
recognizes in its report that many states now have laws requiring a
formal, and in many cases written, informed consent process before
testing. They recommend that the federal government adopt policies that
will encourage these states to change their laws.
The American Academy of Pediatrics (AAP) and the American College of
Obstetricians and Gynecologists (ACOG) strongly support efforts to
further reduce the rate of perinatal transmission of HIV in the United
States. We therefore support the recommendation of the IOM for
universal HIV testing with patient notification as a routine component
of prenatal care. If a patient declines testing, this should be noted
in the medical record. We recognize that current laws in some states
may prevent implementation of this recommendation at this time. We
encourage our members and Fellows to include counseling as a routine
part of care, but not as a prerequisite for and barrier to prenatal HIV
testing.
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FOOTNOTES |
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The recommendations in this statement do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.
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ABBREVIATIONS |
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HIV, human immunodeficiency virus; IOM, Institute of Medicine; AIDS, acquired immunodeficiency syndrome; AAP, American Academy of Pediatrics; ACOG, American College of Obstetricians and Gynecologists.
Pediatrics (ISSN 0031 4005). Copyright ©1999 by the American Academy of Pediatrics
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Statements of reaffirmation:
- AAP Publications Retired and Reaffirmed
Pediatrics 116: 796-796.[Full Text]
-
Policy Statement--AAP Publications Retired and Reaffirmed
Pediatrics 124: 845-845.[Full Text]
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