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Task Force recommends HIV screening for all pregnant women

The U.S. Preventive Services Task Force issued a new recommendation calling for all pregnant women, not just those identified as at risk for contracting HIV, to be screened for the infection. This recommendation is based on evidence that currently available tests accurately identify pregnant women who are HIV infected and that recommended treatment strategies can dramatically reduce the chances that an infected mother will transmit HIV to her infant.

The Task Force also reaffirmed its earlier recommendation that all adolescents and adults at increased risk for HIV infection be screened and has broadened its definition of high risk. In addition to patients who report high-risk behaviors, all patients receiving care in high-risk settings—such as homeless shelters or clinics dedicated to the treatment of sexually transmitted diseases—should be tested. The Task Force found at least fair evidence that screening adolescents and adults who are not at increased risk can improve health outcomes, but they concluded that the balance of benefits and harms is too close to justify a general recommendation. The new recommendations were published in the July 5 issue of the Annals of Internal Medicine.

In 1996, the Task Force recommended a targeted strategy of routine counseling and screening of high-risk pregnant women and those who live in communities with a higher than average rate of HIV-positive newborns. However, recent evidence indicates that prenatal counseling and HIV testing have gained wider acceptance among pregnant women, and that universal testing increases the number of women diagnosed and treated for HIV prior to delivery. Currently recommended treatment of HIV-infected pregnant women has been shown to significantly reduce the number of women who pass the virus to their newborns.

Treatment includes combination drug therapies taken during pregnancy that have been found safe for both mothers and infants. In addition, elective cesarean section and avoidance of breastfeeding have been shown to further reduce the chances that a mother will pass HIV infection to her infant. Infected mothers who receive treatment can reduce the chance that their infants will be infected to as low as 1 percent, as opposed to 25 percent of infants born to HIV-positive mothers who aren't treated during pregnancy.

Since 1995, advancements in treating HIV-positive patients with highly active antiretroviral therapy (HAART), a treatment regimen that combines three or more medications, have been shown to slow the progression of the disease and reduce HIV-related death rates.

There are an estimated 850,000 to 950,000 Americans infected with HIV who are unaware that they have the virus. If left untreated, almost all infected individuals will develop acquired immune deficiency syndrome (AIDS). AIDS is the seventh leading cause of death in Americans between the ages of 15 and 24 and the fifth leading cause of death among those 25 to 44 years old. People who are or have been intravenous drug users, have had sex with an HIV-infected partner, and men who have had sex with men after 1975 are among the groups at high risk for contracting HIV.

In addition, data from AHRQ's Healthcare Cost and Utilization Project indicate that 6,300 of the approximately 4.7 million women who were hospitalized for pregnancy or childbirth in 2002 were infected with HIV.

The Task Force, which is sponsored by the Agency for Healthcare Research and Quality, is the leading independent panel of private-sector experts in prevention and primary care. Task Force recommendations are considered the gold standard for clinical preventive services. The Task Force conducts rigorous, impartial assessments of the scientific evidence for a broad range of preventive services.

For more information, see "Prenatal screening for HIV: A review of the evidence for the U.S. Preventive Services Task Force," by Roger Chou, M.D., Ariel K. Smits, M.D., M.P.H., Laurie H. Huffman, M.S., and others in the July 5, 2005, Annals of Internal Medicine 143(1), pp. 38-54. In the same issue of the journal, see also "Screening for HIV: Recommendation statement," by the U.S. Preventive Services Task Force, pp. 32-37; and "Screening for HIV: A review of the evidence for the U.S. Preventive Services Task Force," by Dr. Chou, Ms. Huffman, Rongwei Fu, Ph.D., and others, pp. 55-73.

The recommendations and materials for clinicians are available on the AHRQ Web site. Go to www.ahrq.gov/clinic/uspstf/uspshivi.htm. Previous Task Force recommendations and summaries of the evidence and related materials are also available online and from the AHRQ Publications Clearinghouse. Clinical information is also available from AHRQ's National Guideline Clearinghouse™ at www.guideline.gov.

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