| Pregnancy, Pediatrics
and HIV Infection: Guidelines for Your Practice Page 3 |
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| A working group of the United States Public Health Service meets monthly to update their recommendations and further reduce the risk of perinatal transmission of HIV. Implementation of the guidelines dramatically reduced pediatric HIV/AIDS cases and exposures. |
| Steps Recommended to Prevent Perinatal HIV Transmission |
| 1. Prenatal Care Preventing perinatal HIV transmission involves a series of events, the first of which is prenatal care. A total of 25% of HIV-infected women in New Jersey do not seek access to prenatal care,2 providing a major challenge in efforts to reduce the risk of perinatal HIV infection. |
| 2. Counseling After a woman has accessed care, HIV testing must be offered and HIV counseling provided. This is mandated in New Jersey by Public Law #174. Counseling should be culturally sensitive and include offering information on prevention. Women who test HIV positive should be made aware of the options to reduce perinatal HIV transmission, including use of AZT and other antiretroviral agents and Cesarean section. Women who are infected with HIV should be cautioned not to breast feed, since breastfeeding can transmit HIV infection to the newborn. |
| 3. Testing Testing for HIV remains voluntary; however, both refusal and acceptance of testing must be documented. If a woman initially refuses HIV testing, it is important to open the discussion with her again on future visits and to remind her of the risk of HIV transmission to her child. She should be informed of the importance of receiving timely treatment for HIV disease. Women should be assured that according to New Jersey Law, Chapter 174 their test results will be held in the strictest confidence. However, in the interest of protecting public health, a physician caring for the woman should make her test results known to the physician caring for her infant. The physician caring for the infant, however, is also bound to keep testing information confidential. |
| Several diagnostic tests are available for the pregnant women. Specimens may be obtained from blood, urine, or transmucosal exudate. Initial screening is done by an enzyme-linked immunosorbent assay (ELISA). If the test is positive, it should be repeated. If the test is repeatedly positive, results must be confirmed by a supplemental test known as the Western Blot. The Western Blot should be conducted before laboratory results are revealed to the women. |
| In order to provide rapid HIV diagnosis for women with no prenatal care and other groups of patients with unknown HIV status some institutions and/or States offer a rapid or expedited test to that population. An expedited test usually represents 2 positive ELISA tests on two separate blood samples from the same patient with a confirmatory Western blot. Rapid HIV tests can provide a presumptive diagnosis of HIV infection within 1 hour. The rapid test is confirmed with a rapid test from another manufacturer or a Western blot. |
| The OraQuick Rapid HIV-I Antibody Test was approved by the FDA in November 2002 for use on whole blood from a fingerstick. The OraQuick test has very high sensitivity (99.6%) and specificity (100%) and should be confirmed with a Western Blot. The Reveal HIV-1 Antibody Test was also approved by the FDA. Information on the availability of rapid HIV tests is on the CDC web site at: CDC Website . Access to rapid HIV testing will allow us to offer intrapartum and early Neonatal therapy to HIV infected women without prior prenatal care. |
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