Despite
laws, many pregnant women lack HIV testing
by Toni Baker
Despite state laws requiring that every pregnant woman be offered HIV testing multiple times during pregnancy, most aren’t tested in their third trimester and a small percentage are never offered testing, according to a review of Florida women from 2004-05.
Rapid HIV testing performed on 1,867 women at a Pensacola hospital from April 2004 through March 2005 who lacked proof of testing when they reached the delivery room identified two HIV-positive mothers, said Dr. Andrew W. Helfgott, chief of the MCG Section of Maternal-Fetal Medicine. Doctors were able to preventively reduce the babies’ infection risk, he said.
“Rapid testing is an easy, relatively inexpensive means of identifying women who are infected, treating them and their babies, and preventing perinatal infection,” said Dr. Helfgott.
The last-minute testing cost $27,000, far less than the lifetime cost of treating even one infected child, he said. Of the women who received rapid testing in labor and delivery, 72.1 percent had no previous third-trimester test and 2 percent hadn’t been offered testing at all earlier in their pregnancy.
Availability of the 20-minute, highly accurate tests that can be used even in the last minutes of pregnancy should preclude HIV infection in every newborn, he said. Still, an estimated 280 to 370 HIV-infected children are born each year in this country.
Dr. Helfgott was directing a high-risk pregnancy program in Pensacola in 2002 when Florida led the nation with 37 perinatal transmissions. He started working with the Centers for Disease Control and Prevention and Florida Department of Health Bureau of HIV officials to stress the importance of testing.
Florida laws were changed requiring that women be offered testing in the first and third trimesters and rapid testing if they lacked proof of HIV status in labor and delivery. Since then, the laws have been further strengthened, making HIV a standard part of prenatal testing unless a woman opts out.
Dr. Helfgott presented his findings May 8 during The American College of Obstetricians and Gynecologists 54th annual meeting in Washington, D.C.
There is no law requiring testing in pregnancy in Georgia despite the 25 percent chance of an infected mother infecting her child, said Dr. Helfgott, who is working with state officials to raise awareness of the need for testing.
The infection risk can drop to less than 2 percent if an HIV-positive woman gets treatment during pregnancy or labor and delivery and the baby gets treatment in the first six weeks of life, he said. Even if treatment is given only to the baby within 48 hours of birth, the risk is reduced to about 6 percent, Dr. Helfgott says.
“The problem we found in Pensacola is the women either didn’t get offered testing in the third trimester or – and this will remain a problem all over the country until we go totally to electronic medical records – we had trouble getting prenatal care records while women were in labor and delivery,” he said.
Greater awareness of the need for testing coupled with the ability to quickly test women in labor could achieve the goal of eliminating perinatal transmission, he said.
It appears to be working in Florida: The state reported one perinatal transmission in fiscal 2004-05.