A rapid HIV test is a screening test that produces very quick results, in approximately 20 minutes. Rapid tests use blood from a vein or from a finger stick, or oral fluid, to look for the presence of antibodies to HIV. A standard HIV test may take several days to obtain a result.
All pregnant women should be counseled on the importance of knowing their HIV status. In Illinois, state law requires that all pregnant women be counseled and recommended an HIV test. This counseling should ideally take place during the first prenatal visit. Additionally, it is recommended that women at high risk for contracting HIV be retested during the third trimester of pregnancy. In Illinois, women who do not receive prenatal care and/or have an undocumented HIV status at the time of labor and delivery, are counseled and recommended a rapid HIV test. All preliminary positive rapid HIV tests must then be confirmed by a subsequent supplemental HIV test different from the initial test.
If a woman is HIV negative and her partner is HIV positive, there is no risk of perinatal transmission to the baby. However, pregnant women are STILL AT RISK for acquiring HIV infection and condoms must be used every time the couple has intercourse to prevent transmission of HIV to the mother while pregnant. A woman who becomes HIV positive while pregnant has a greater chance of transmitting the virus to her baby. Women in this and all high risk situations should be retested for HIV during the third trimester.
Tremendous strides have been made in the care of pregnant women living with HIV. Because of this progress the risk of vertical transmission (when HIV is transmitted from a mother to her baby) can be as low as less than 1%. Maximum reduction in transmission occurs when a woman knows her HIV status early in pregnancy and receives treatment in the prenatal period and during labor and her infant receives treatment once he or she is born. Some women present to labor and delivery without a documented HIV test or may require repeat HIV testing in the third trimester. In these cases a rapid HIV test on labor and delivery is necessary. It is critical that a woman’s HIV status is known because appropriate medical decisions can be made at the time of delivery that have the potential to reduce the risk of HIV transmission by almost half. The sooner a doctor or nurse knows that a woman is HIV positive, the sooner treatment can be started, and the greater the chance her baby will be born HIV negative.
Integrated HIV/OB care is essential for the best treatment of a woman who is pregnant and infected by HIV/AIDS. Both obstetric and infectious disease issues must be considered when recommending an antiretroviral regimen. A regimen needs to be followed and adjusted throughout pregnancy to achieve the goal of viral suppression at delivery. Ideally, infectious disease and obstetrical visits can be scheduled together to make it easier for the patient to make all appointments.
If possible, prenatal care for all HIV positive women should be provided by an obstetrician experienced in the care of HIV positive patients. If this is not possible, physicians caring for these women should request a consultation with a physician experienced in the care of HIV positive patients who can assist with mapping out an appropriate care plan for the patient.
Any woman who presents to labor and delivery without a documented HIV test during the current pregnancy.
Any woman with a negative HIV test result early in pregnancy who is at increased risk of acquiring HIV during pregnancy should be offered repeat testing in the third trimester. This includes women who:
- have a history of sexually transmitted infections
- participate in the exchange of sex for money or drugs
- have had multiple sex partners during the current pregnancy
- use illicit drugs
- have a sex partner[s] known to be HIV positive or at high risk for an HIV infection
- have signs and symptoms of seroconversion
If a patient presents to labor and delivery without documented third trimester testing and warrants repeat testing a rapid HIV test can be offered.
Infectious disease specialists are imperative when it comes to prescribing medications which can help to achieve rapid and sustained viral suppression. Infectious disease specialists are experienced in identifying possible drug interactions, monitoring for signs of drug toxicity and managing the troubling side effects which sometimes hinder medical compliance of antiretroviral therapies. Finally it is important that persons infected with HIV who have severely compromised immune systems be monitored by infectious disease specialists for the possible development of opportunistic infections and to receive appropriate prophylactic medications.
The Illinois Perinatal HIV Prevention Act (410 ILCS 335/) aims to eliminate HIV transmission from mothers to newborns. The U.S. Centers for Disease Control and Prevention (CDC) recommended in 2006 that providers conduct opt-out HIV testing of pregnant women. According to the CDC, before testing, providers should counsel pregnant women about the benefits of HIV testing, inform them that they will be tested unless they decline, explain how to decline, advise that HIV testing is voluntary, and test the women for HIV unless they decline. Illinois Public Law 95-702, effective June 1, 2008, implements these guidelines, mandates the counseling before the offer of testing and permits opt-out HIV testing. For additional information about the law, click here