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Screening for HIV in Pregnant Women: Systematic Review to Update the 2005 U.S. Preventive Services Task Force Recommendation

Roger Chou, MD; Amy G. Cantor, MD, MHS; Bernadette Zakher, MBBS; and Christina Bougatsos, MPH
[+] Article and Author Information

From the Oregon Evidence-based Practice Center and Oregon Health & Science University, Portland, Oregon.

Acknowledgment: The authors thank Tracy Dana, MLS; Ian Blazina, MPH; Laurie Hoyt Huffman, MS; and Jennifer Croswell, MD, MPH. They also thank U.S. Preventive Services Task Force Leads Susan Curry, PhD; Virginia Moyer, MD, MPH; Wanda Nicholson, MD, MPH, MBA; and Timothy Wilt, MD, MPH.

Grant Support: By contract 290-02-0024 from the Agency for Healthcare Research and Quality.

Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-1201.

Requests for Single Reprints: Roger Chou, MD, Oregon Health & Science University, 3181 Southwest Sam Jackson Park Road, Mail Code BICC, Portland, OR 97239; e-mail, chour@ohsu.edu.

Current Author Addresses: Drs. Chou, Cantor, and Zahker and Ms. Bougatsos: Oregon Health & Science University, 3181 Southwest Sam Jackson Park Road, Mail Code BICC, Portland, OR 97239.

Author Contributions: Conception and design: R. Chou, C. Bougatsos.

Analysis and interpretation of the data: R. Chou, A.G. Cantor, B. Zakher, C. Bougatsos.

Drafting of the article: R. Chou, A.G. Cantor, B. Zakher, C. Bougatsos.

Critical revision of the article for important intellectual content: R. Chou, A.G. Cantor, B. Zakher.

Final approval of the article: R. Chou, A.G. Cantor, B. Zakher.

Statistical expertise: R. Chou.

Obtaining of funding: R. Chou.

Administrative, technical, or logistic support: R. Chou, A.G. Cantor, C. Bougatsos.

Collection and assembly of data: R. Chou, B. Zakher, C. Bougatsos.


Ann Intern Med. 2012;157(10):719-728. doi:10.7326/0003-4819-157-10-201211200-00009
Text Size: A A A

Background: A 2005 U.S. Preventive Services Task Force (USPSTF) review found good evidence that prenatal HIV screening is accurate and can lead to interventions that reduce the risk for mother-to-child transmission.

Purpose: To update the 2005 USPSTF review, focusing on previously identified research gaps and new evidence on treatments.

Data Sources: MEDLINE (2004 to June 2012) and the Cochrane Library (2005 to the second quarter of 2012).

Study Selection: Randomized trials and cohort studies of pregnant women on risk for mother-to-child transmission or harms associated with prenatal HIV screening or antiretroviral therapy during pregnancy.

Data Extraction: 2 reviewers abstracted and confirmed study details and quality by using predefined criteria.

Data Synthesis: No studies directly evaluated effects of prenatal HIV screening on risk for mother-to-child transmission or maternal or infant clinical outcomes. One fair-quality, large cohort study (HIV prevalence, 0.7%) found that rapid testing during labor was associated with a positive predictive value of 90%. New cohort studies of nonbreastfeeding women in the United States and Europe confirm that full-course combination antiretroviral therapy reduces rates of mother-to-child transmission (<1% to 2.4% vs. 9% to 22% with no antiretroviral therapy). New cohort studies found antiretroviral therapy during pregnancy to be associated with increased risk for preterm delivery (<37 weeks' gestation); there were no clear associations with low birthweight, congenital abnormalities, or infant neurodevelopment. Evidence on long-term maternal harms after short-term antiretroviral therapy exposure during pregnancy remains sparse.

Limitations: Only English-language articles were included. Studies conducted in resource-poor settings may be of limited applicability to screening in the United States.

Conclusion: Antiretroviral therapy in combination with avoidance of breastfeeding and elective cesarean section in women with viremia reduces risk for mother-to-child transmission. Use of certain antiretroviral therapy regimens during pregnancy may increase risk for preterm delivery.

Primary Funding Source: Agency for Healthcare Research and Quality.

Figures

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Figure.

Analytic framework and key questions for screening for HIV in pregnant women.

Ab = antibody.

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Appendix Figure.

Evidence search and selection.

* Includes the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews.

† Include reference lists suggested by peer reviewers.

‡ Some articles are included for more than 1 key question. § These studies were included in the full report but omitted from the manuscript.

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