How should staff manage a pregnant patient with a preliminary positive rapid HIV test in labor and delivery?

Patients with a preliminary positive rapid HIV test who are in active labor should be counseled on the test result, the risk of vertical transmission, and the potential benefit of a cesarean delivery in reducing that risk. The birthing patient should be treated as positive, until confirmatory tests prove otherwise. The Department of Health and Human Services Perinatal Guidelines indicate that intravenous zidovudine (AZT) should be initiated immediately and that blood be sent for a supplemental HIV test to confirm the positive rapid HIV result. If needed, expedited confirmatory HIV testing is available through the Illinois Perinatal HIV Hotline with results generally obtained within 24 hours. Please call 1-800-439-4079 for additional information or specific questions. The neonate should also be managed as though the birthing parent is positive, until confirmatory tests prove otherwise. See the Illinois Perinatal HIV Hotline’s Best Practices: Labor & Delivery Care for Pregnant People with HIV and Care of Infants with Perinatal Exposure to HIV including those with a positive rapid HIV test.