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*Routine prenatal HIV testing with streamlined counseling and consent procedures has increased the number of pregnant women tested substantially .
*Routine prenatal HIV testing with streamlined counseling and consent procedures has increased the number of pregnant women tested substantially .
==Screening for HIV in Pregnant Women and Their Infants==
==Screening for HIV in Pregnant Women and Their Infants==
*Public health services (PHS) recommends that all pregnant women in the United States be tested for HIV infection. All health-care providers should recommend HIV testing to all of their pregnant patients, pointing out the substantial benefit of knowledge of HIV status for the health of women and their infants. HIV screening should be a routine part of prenatal care for all women.
==Reference==
==Reference==
{{reflist|2}}
{{reflist|2}}

Revision as of 20:30, 23 February 2012

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editors-in-Chief: Ujjwal Rastogi, MBBS [2]

Overview

At the end of 2006, an estimated 1,106,400 persons (range: 1,056,400 – 1,156,400) in the United States were living with HIV. CDC estimates that 56,300 new HIV infections occurred in the United States in 2006.[1] About 1 million Americans have HIV — to a surprise, an estimated 25 percent do not know they have the infection. Therefore, HIV screening is important to both extend their lives and prevent further spreading of the disease.

Screening

HIV can be transmitted to a person receiving blood or organs from an infected donor. To reduce this risk, blood banks and organ donor programs screen donors, blood, and tissues thoroughly. People who received blood transfusions or clotting products between 1977 and 1985 (before screening for the virus became standard practice) are at highest risk for getting HIV. Basic screening lab tests and regular cervical Pap smears are important to monitor in HIV infection, due to the increased risk of cervical cancer in women with a compromised immune system.

Timing of HIV screening

CDC recommends that everyone ages 13-64 be tested once for HIV.

Rationale for Routine Screening for HIV Infection

  • People who are infected with HIV but not aware of it are not able to take advantage of the therapies that can keep them healthy and extend their lives, nor do they have the knowledge to protect their sex or drug-use partners from becoming infected. Knowing whether one is positive or negative for HIV confers great benefits in healthy decision making.
  • Cohort studies have demonstrated that many infected persons decrease behaviors that help transmit infection to sex or needle-sharing partners once they are aware of their positive HIV status.[2][3][4]
  • HIV-infected persons who are unaware of their infection do not reduce risk behaviors.[5][6][7]
  • Persons tested for HIV who do not return for test results might even increase their risk for transmitting HIV to partners.[8]
  • Early referral to medical care could prevent HIV transmission in communities while reducing a person's risk for HIV-related illness and death, because medical treatment that lowers HIV viral load might also reduce risk for transmission to others.[9]
  • HIV infection is consistent with all generally accepted criteria that justify screening:
  1. HIV infection is a serious health disorder that can be diagnosed before symptoms develop.
  2. HIV can be detected by reliable, inexpensive, and noninvasive screening tests.
  3. Infected patients have years of life to gain if treatment is initiated early, before symptoms develop.
  4. The costs of screening are reasonable in relation to the anticipated benefits.[10] Among pregnant women, screening has proven substantially more effective than risk-based testing for detecting unsuspected maternal HIV infection and preventing perinatal transmission.[11][12][13]

Screening donor blood and cellular products

Tests selected to screen donor blood and tissue must provide a high degree of confidence that HIV will be detected if present (that is, a high sensitivity is required). A combination of antibody, antigen and nucleic acid tests are used by blood banks in Western countries. The World Health Organization estimated that, inadequate blood screening had resulted in 1 million new HIV infections worldwide.

In the USA, since 1985, all blood donations are screened with an ELISA test for HIV-1 and HIV-2, as well as a nucleic acid test. These diagnostic tests are combined with careful donor selection. The risk of transfusion-acquired HIV in the U.S. was approximately one in 2.5 million for each transfusion.[14]

Human rights

The UNAIDS/WHO policy statement on HIV Testing states that conditions under which people undergo HIV testing must be anchored in a human rights approach that pays due respect to ethical principles.[15] According to these principles, the conduct of HIV testing of individuals must be

Confidentiality

Considerable controversy exists over the ethical obligations of health care providers to inform the sexual partners of individuals infected with HIV that they are at risk of contracting the virus.[16] Some legal jurisdictions permit such disclosure, while others do not. More state funded testing sites are now using confidential forms of testing. This allows for monitoring of infected individuals easily, compared to anonymous testing that has a number attached to the positive test results. Controversy exists over privacy issues.

In developing countries, home-based HIV testing and counseling (HBHTC) is an emerging approach for addressing confidentiality issues. HBHTC allows individuals, couples, and families to learn their HIV status in the convenience and privacy of their home environment. Rapid HIV tests are most often used, so results are available for the client between 15 and 30 minutes. Furthermore, when an HIV positive result is communicated, the HTC provider can offer appropriate linkages for prevention, care, and treatment.[17]

Anonymous testing

Testing that has only a number attached to the specimen that will be delivered for testing. Items that are confirmed positive will not have the HIV infected individual's name attached to the specimen. Sites that offer this service advertise this testing option.

Routine testing recommendation

  • In the United States, one emerging standard of care is to screen all patients for HIV in all health care settings.[18]
  • In 2006, the Centers for Disease Control announced an initiative for voluntary, routine testing of all Americans aged 13–64 during health care encounters. An estimated 25% of infected individuals were unaware of their status; If successful the effort was expected to reduce new infections by 30% per year.[19]
  • The CDC recommends elimination of requirements for written consent or extensive pre-test counseling as barriers to widespread routine testing.[19]
  • Routine prenatal HIV testing with streamlined counseling and consent procedures has increased the number of pregnant women tested substantially .

Screening for HIV in Pregnant Women and Their Infants

  • Public health services (PHS) recommends that all pregnant women in the United States be tested for HIV infection. All health-care providers should recommend HIV testing to all of their pregnant patients, pointing out the substantial benefit of knowledge of HIV status for the health of women and their infants. HIV screening should be a routine part of prenatal care for all women.

Reference

  1. ↑ Hall HI, Song R, Rhodes P, Prejean J, An Q, Lee LM, Karon J, Brookmeyer R, Kaplan EH, McKenna MT, Janssen RS (2008). "Estimation of HIV incidence in the United States". JAMA. 300 (5): 520–9. doi:10.1001/jama.300.5.520. PMC 2919237. PMID 18677024. Retrieved 2012-02-23. Unknown parameter |month= ignored (help)
  2. ↑ Coates TJ, Morin SF, McKusick L (1987). "Behavioral consequences of AIDS antibody testing among gay men". JAMA. 258 (14): 1889. PMID 3477652. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  3. ↑ Wenger NS, Linn LS, Epstein M, Shapiro MF (1991). "Reduction of high-risk sexual behavior among heterosexuals undergoing HIV antibody testing: a randomized clinical trial". Am J Public Health. 81 (12): 1580–5. PMC 1405278. PMID 1746653. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  4. ↑ Fox R, Odaka NJ, Brookmeyer R, Polk BF (1987). "Effect of HIV antibody disclosure on subsequent sexual activity in homosexual men". AIDS. 1 (4): 241–6. PMID 3126772. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  5. ↑ Wenger NS, Kusseling FS, Beck K, Shapiro MF (1994). "Sexual behavior of individuals infected with the human immunodeficiency virus. The need for intervention". Arch. Intern. Med. 154 (16): 1849–54. PMID 8053754. Retrieved 2012-02-23. Unknown parameter |month= ignored (help)
  6. ↑ Dawson J, Fitzpatrick R, McLean J, Hart G, Boulton M (1991). "The HIV test and sexual behaviour in a sample of homosexually active men". Soc Sci Med. 32 (6): 683–8. PMID 2035044. |access-date= requires |url= (help)
  7. ↑ Desenclos JC, Papaevangelou G, Ancelle-Park R (1993). "Knowledge of HIV serostatus and preventive behaviour among European injecting drug users. The European Community Study Group on HIV in Injecting Drug Users". AIDS. 7 (10): 1371–7. PMID 8267911. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  8. ↑ Otten MW, Zaidi AA, Wroten JE, Witte JJ, Peterman TA (1993). "Changes in sexually transmitted disease rates after HIV testing and posttest counseling, Miami, 1988 to 1989". Am J Public Health. 83 (4): 529–33. PMC 1694465. PMID 8460729. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  9. ↑ Quinn TC, Wawer MJ, Sewankambo N, Serwadda D, Li C, Wabwire-Mangen F, Meehan MO, Lutalo T, Gray RH (2000). "Viral load and heterosexual transmission of human immunodeficiency virus type 1. Rakai Project Study Group". N. Engl. J. Med. 342 (13): 921–9. doi:10.1056/NEJM200003303421303. PMID 10738050. Retrieved 2012-02-23. Unknown parameter |month= ignored (help)
  10. ↑ Wilson JM, Jungner YG (1968). "[Principles and practice of mass screening for disease]". Bol Oficina Sanit Panam (in Spanish; Castilian). 65 (4): 281–393. PMID 4234760. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  11. ↑ Barbacci MB, Dalabetta GA, Repke JT, Talbot BL, Charache P, Polk BF, Chaisson RE (1990). "Human immunodeficiency virus infection in women attending an inner-city prenatal clinic: ineffectiveness of targeted screening". Sex Transm Dis. 17 (3): 122–6. PMID 2247801. |access-date= requires |url= (help)
  12. ↑ Fehrs LJ, Hill D, Kerndt PR, Rose TP, Henneman C (1991). "Targeted HIV screening at a Los Angeles prenatal/family planning health center". Am J Public Health. 81 (5): 619–22. PMC 1405093. PMID 2014863. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  13. ↑ Lindsay MK, Adefris W, Peterson HB, Williams H, Johnson J, Klein L (1991). "Determinants of acceptance of routine voluntary human immunodeficiency virus testing in an inner-city prenatal population". Obstet Gynecol. 78 (4): 678–80. PMID 1923172. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  14. ↑ Adverse reactions associated with blood transfusion. From the Puget Sound Blood Center. Accessed 5 Oct 2006.
  15. ↑ UNAIDS/WHO policy statement on HIV Testing (PDF), accessed 5 Oct 2006.
  16. ↑ JM Appel (2006). "Must My Doctor Tell My Partner? Rethinking Confidentiality in the HIV Era". Medicine and Health Rhode Island. 89 (6): 223–4. PMID 16875013. Unknown parameter |month= ignored (help)
  17. ↑ http://www.aidstar-one.com/focus_areas/hiv_testing_and_counseling/resources/case_study_series/getting_in_the_door
  18. ↑ Armstrong WS, Taege AJ (2007). "HIV screening for all: the new standard of care". Cleve Clin J Med. 74 (4): 297–301. doi:10.3949/ccjm.74.4.297. PMID 17438679. Unknown parameter |month= ignored (help)
  19. ↑ 19.0 19.1 CDC fact sheet

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