Question

Dear Doctor, Could you please tell me whether it is now standard practice for pregnant women to be tested for HIV, ie. is HIV one of the test included in the standard prenatal blood test given to pregnant women. If a woman tests positive, what is the usual treatment and when does it have to begin to be effective? Thank you.

Answer

It is absolutely, positively recommended that all pregnant women be offered an HIV test. However, it is still all too common for doctors not to mention it to a pregnant woman. In most states, you must sign a separate consent to be tested. If you were not told you were being tested, you may not have been.

Treatment is recommended for all HIV infected pregnant women. There are two reasons. The first is to protect the woman's health. This will depend on the stage of her illness. The second is to prevent transmission to the baby, for which antiretroviral drugs are VERY effective. In general, we try an wait until after the end of the first trimester (ie until after the end of the first month). There is still a benefit of treatment even if it is started later in pregnancy, even up until the time of labor.

The subject is complicated, and I can't review it all here. A pregnant woman with HIV should be cared for by someone with expertise in HIV and pregnancy - either an OB/GYN working with an AIDS doctor, or an OB/GYN with extensive experience in using antiretrovirals (there are a handful of them). More information can be found by following other links on this site and looking at the children and pregnancy forum.

ATP

Andrew T. Pavia, M.D.