Screening for HIV in pregnant women: Systematic review to update the 2005 U.S. Preventive Services Task Force recommendation

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-tochild 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.