Women Entering Labor Should Be Given Rapid HIV Test To Determine Treatment To Prevent Vertical HIV Transmission, Study Says
Women entering labor whose HIV status is unknown should be given a rapid HIV test to determine whether treatment is necessary to reduce the likelihood of mother-to-child transmission, according to a study to be published in the July 14 issue of the Journal of the American Medical Assocaition, the Los Angeles Times reports (Maugh, Los Angeles Times, 7/12). CDC researcher Dr. Marc Bulterys and colleagues asked 5,744 women in the United States who previously had not been tested for HIV to undergo rapid testing with Orasure Technologies' OraQuick test during labor at 16 hospitals nationwide; 84%, or 4,849 women, consented to the test. Women who tested HIV-positive were treated with zidovudine and some also received nevirapine to help prevent mother-to-child HIV transmission. Women who received a positive result from OraQuick also underwent conventional HIV testing, and researchers found that four women had received false-positive results from the rapid test, according to the AP/Biloxi Sun Herald.
Dr. Mardge Cohen, a study co-author and an AIDS specialist at John H. Stroger Jr. Hospital in Chicago, said that the OraQuick testing process -- which involves conducting a finger-prick blood test; obtaining results; and explaining the results to the women -- took an average of 66 minutes to complete. The process provides enough time to begin treatment while labor progressed, according to the AP/Sun Herald. Cohen said that infants who are born to HIV-positive women who did not receive antiretroviral treatment before delivery and who did not receive treatment shortly after birth have a 25% chance of contracting HIV, the AP/Sun Herald reports. However, he added that optimal treatment for the infant and the woman can decrease the risk of transmission to 2%. Of the thirty-four women who tested HIV-positive and received treatment during labor, only three of their infants tested positive for HIV, according to the study (Tanner, AP/Biloxi Sun Herald, 7/11). The researchers concluded that rapid HIV tests can be administered "successfully to women in labor" and can "contribute to dramatic reductions" in the number of infants who are born HIV-positive, according to the Chicago Tribune (Graham, Chicago Tribune, 7/11). The rapid screening could be particularly valuable in developing countries where many pregnant women do not access health care until they are in labor. It is unclear whether the testing recommendations will be announced at the XV International AIDS Conference as originally planned because Bulterys was unable to attend due to HHS travel restrictions on conference attendees, the Times reports (Los Angeles Times, 7/12).
Other studies in the special HIV/AIDS-themed edition include:
- "Efficacy of an HIV Prevention Intervention for African-American Adolescent Girls: A Randomized Controlled Trial" (DiClemente et al., JAMA, 7/14).
- "Rapid HIV-1 Testing During Labor: A Multicenter Study" (Bulterys et al., JAMA, 7/14).
- "Efficacy and Safety of Emtricitabine vs Stavudine in Combination Therapy in Antiretroviral-Naive Patients: A Randomized Trial" (Saag et al., JAMA, 7/14).
- "Efficacy and Safety of Tenofovir DF vs. Stavudine in Combination Therapy in Antiretroviral-Naive Patients: A three-Year Randomized Trial" (Gallant et al., JAMA, 7/14).
- "Nevirapine and Zidovudine at Birth To Reduce Perinatal Transmission of HIV in an African Setting: A Randomized Controlled Trial" (Taha et al., JAMA, 7/14).
- "Growth Hormone-Releasing Hormone in HIV-Infected Men With Lipodystrophy: A Randomized Controlled Trial" (Polyxeni Koutkia et al., JAMA, 7/14).
- "Highly Active Antiretroviral Therapy and Sexual-Risk Behavior: A Meta-analytic Review" (Crepaz et al., JAMA, 7/14).
- "Clinical Trials in Sub-Saharan Africa and Established Standards of Care: A Systematic Review of HIV, Tuberculosis and Malaria Trials" (Kent et al., JAMA, 7/14).
- "Treatment for Adult HIV Infection: 2004 Recommendations of the International AIDS Society-USA Panel" (Yeni et al., JAMA, 7/14).
- "HIV Infection, Hepatitis C Infection and HAART: Hard Clinical Choices" (Kottilil et al., JAMA, 7/14).
- "Treatment of HIV/AIDS: Do the Dilemmas Only Increase?" (Sande/Allan, JAMA, 7/14).
- "Conquering HIV and Stigma in Kenya" (Voelker, JAMA, 7/14).
- "Report: HIV Prevention Efforts Remain Crucial as Global Treatment Access Expands" (Stephenson, JAMA, 7/14).