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James P. Harisiades, MPH
Office of Child Advocacy,
Children's Memorial Hospital,
Chicago, IL 60614-3394
To the Editor.—
We fully concur with the assertion of Goldschmidt and Fogler that "pediatricians will be called on more and more to exercise their essential role in helping to eliminate perinatal HIV in the United States."1 However, their commentary omitted the critical opportunity to prevent at least a third of mother-to-newborn HIV infection in vulnerable HIV-exposed newborns if they are started on anti-HIV prophylaxis within 48 hours after birth.2 With the advent of rapid HIV testing that is now available, we have the opportunity to prevent HIV infection in newborns whose mothers' HIV status is unknown immediately after birth (ie, within 48 hours) by performing rapid testing (which yields results in <20–30 minutes) and administering immediate (and uninterrupted) antiretroviral prophylaxis.3 This can be done even if the mother has had no prenatal care or refuses HIV testing and treatment for herself before and during delivery.
Currently, many pregnant women in the United States refuse HIV testing during labor and delivery, even with intensive counseling. A recent study evaluating rapid HIV testing of pregnant women in labor found that only 84% accepted rapid testing.4 More compelling is that this particular population of women (who refuse to be tested) is at increased risk for being HIV positive.5
Since 1994, when science first demonstrated that transmission of HIV from mother to newborn could be prevented through prenatal testing and treatment, there still have been thousands of children infected with HIV in the United States that could have been prevented. Accordingly, postnatal interventions must also be used when prenatal efforts fail. Although testing, educating, and treating the pregnant woman before birth represent the most effective opportunity to prevent mother-to-newborn HIV transmission, routine newborn testing beginning at the earliest stages of life when the status of the mother is unknown at birth must be used by pediatricians to prevent needless HIV infection in accordance with our fundamental professional responsibility to optimize health outcomes for children. In states such as New York and Connecticut that routinely test newborns for HIV, mother-to-newborn HIV transmission has been reduced by >99%.
There is also an economical advantage. The rapid HIV test costs $10 to administer and the preventive treatment costs $75, in comparison to at least $10000 per year to treat a newborn with HIV, with life expectancies now exceeding 2 decades. Clearly, this savings in human suffering and cost should be compelling reasons for every pediatrician to immediately integrate this new opportunity (ie, rapid HIV testing of newborns whose mothers' HIV status is unknown) into standard practice. We hope that Drs Goldschmidt and Fogler agree.
REFERENCES
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