Government research shows a rapid HIV test can be used on women during childbirth, results that doctors hope will help reduce HIV infections in newborns.
Though HIV infection of newborns is not widespread in the United States, it is of great concern in Africa and other developing areas.
Interrupting the often excruciating yet exhilarating experience of childbirth to test and tell a woman she's infected may seem almost cruel _ but it gives doctors a good chance of preventing her baby from becoming infected, too, said study co-author Dr. Mardge Cohen.
It takes about 20 minutes to get results from rapid tests compared with more than a day for conventional HIV testing. Testing during childbirth allows doctors to begin treating the mother during labor _ when most mother-to-infant infections occur _ and to start early preventive treatment in newborns.
"It is a very difficult time and a very special time, and to learn very bad news but to have the opportunity to do something about that" is worthwhile, said Cohen, an AIDS specialist at Chicago's John H. Stroger Jr. Hospital of Cook County. The research is reported in Wednesday's issue of the Journal of the American Medical Association.
The federal Centers for Disease Control and Prevention estimates that some 300 or so U.S. infants are born each year infected with the virus that causes AIDS, despite recommendations for prenatal HIV testing and for use of AIDS drugs during pregnancy in infected women.
An estimated 700,000 children worldwide developed HIV infections last year, most in Africa and from mother-to-child transmission during childbirth or early infancy. The problem is especially acute in southern Africa, where about 1 in 5 pregnant women has HIV but is unaware of it and many don't see a doctor until giving birth.
Without drug treatment before birth for mothers and shortly thereafter for newborns, babies born to infected women have a 25 percent chance of becoming infected. With optimal treatment of the mother, the transmission rate drops to less than 2 percent, Cohen said.
The odds increase if the mother isn't treated until she's in labor, but that's still better than no treatment at all.
In the study, HIV was diagnosed in three of 34 babies born to HIV-infected women who got tested and treated during labor, about 10 percent.
The study involved 5,744 previously untested women at 16 U.S. hospitals who were asked to undergo rapid testing during labor. The vast majority _ 84 percent or 4,849 women _ consented.
"They're in pain, they're having contractions, they have a lot else going on" but still agreed to be tested, Cohen said. "It's totally encouraging."
The rapid test used, Orasure Technologies' OraQuick test, involves a finger-prick blood test and was approved for U.S. use in 2002. Orasure provided the kits but had no other involvement in the study, which was funded by the CDC and led by the CDC's Dr. Marc Bulterys.
It took an average of 66 minutes to test, get results and explain them to the women _ plenty of time to begin treatment while labor was still progressing, Cohen said.
Rapid results were followed by conventional testing, which showed no infection in four women who had tested positive on the rapid test, and drugs were stopped in them. Conventional tests confirmed all negative rapid-test results.
Treatment for HIV-exposed infants was generally AZT (zidovudine) syrup every six hours for six weeks; some also got a single dose of nevirapine, an inexpensive AIDS drug shown to help prevent mother-to-child transmission. Infected mothers also got AZT and some received nevirapine, too.
"The results have important implications for individual U.S. patients" but could have the greatest public health benefits if they prompt practice changes in Africa, which could help reduce health inequities between rich and poor countries, according to a JAMA editorial by two Harvard physicians.
"The ability to screen women rapidly for HIV infections and offer antiretroviral therapy has the potential to prevent HIV transmission to hundreds of thousands of infants that otherwise might occur," said editorial authors Drs. Timothy Brewer and S. Jody Heymann.
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JAMA: http://jama.ama-assn.org
World Health Organization: http://www.who.int/hiv
