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August 2005 The U.S. Preventive Services Task Force issued new recommendations, one strongly recommending that health care providers screen all pregnant women for HIV, not just those identified as at risk.
The task force based this recommendation on evidence that testing accurately identify pregnant women with HIV and that recommended treatment strategies can reduce the risk of transmitting HIV to the infant. The task force also reaffirmed its earlier recommendation that health care providers screen all adolescents and adults at increased risk for HIV, and it has broadened its definition of high risk. In addition to patients who report high-risk behaviors, all patients receiving care in high-risk settings, such as homeless shelters or sexually transmitted diseases (STDs) clinics, should be tested. The task force found fair evidence that screening people who are not at increased risk can improve health outcomes, but concluded that the pros and cons are too close to justify a general recommendation. The new clinical recommendations suggest that health care providers screen all pregnant women and anyone at increased risk for HIV. The task force made no recommendation for or against routinely screening for HIV among people who are not at increased risk. High-risk individuals are those reporting one or more risk factors or those who receive health care in a high-prevalence clinical setting. Evaluate individual risk by careful patient history, the task force said. The task force considers the following groups high risk: men who have sex with men; those who have unprotected sex with multiple partners; injecting drug users (IDUs); those who exchange sex for money or drugs or have partners that do so; those whose past or present partners have HIV, are bisexual or IDUs; those with STDs; and those with a history of a blood transfusion between 1978 and 1985. In 1996, the task force recommended a targeted strategy of routine counseling and screening of high-risk pregnant women and those who live in communities with a higher rate of HIV newborns. However, recent evidence indicates that universal testing increases the number of women diagnosed and treated for HIV prior to delivery. Mothers who receive treatment can reduce the chance that their infants will acquire the disease to as low as 1%, as opposed to 25% of infants born to HIV-positive mothers who are not treated during pregnancy. “This recommendation is an important advancement in reducing the rates of HIV in the United States,” said Diana Petitti, MD, task force vice-chair. “More accurate HIV testing during pregnancy and new treatments for HIV have been shown to be safe and effective for mothers and infants and may reduce the number of infants born with the disease.” For more information: |
