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 offered an opt-out HIV test twice during pregnancy. This counseling and testing should ideally take place during the first prenatal visit and again during the third trimester, ideally by the 36th week of pregnancy. In Illinois, women who do not have documentation of HIV testing during the third trimester of pregnancy are counseled and offered opt-out rapid HIV testing upon presentation to labor and delivery. 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 negative for HIV and her partner is living with HIV, there is no risk of perinatal transmission to the baby. However, pregnant women are at an increased risk for HIV infection and a woman who acquires HIV while pregnant has a greater chance of transmitting the virus to her baby. HIV-negative women in a sero-different relationship should seek counseling on the multiple measures that can be taken to prevent infection, including ensuring her partner keeps their virus suppressed by taking medications, taking a medication called pre-exposure prophylaxis (PrEP), and consistently using condoms with each episode of intercourse. Because of the ongoing risk of HIV infection, all women in Illinois are required to be counseled and offered an HIV test both at the initial prenatal visit and again in their third trimester of pregnancy.

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 has HIV, the sooner treatment can be started, and the greater the chance her baby will be born without HIV.

Integrated HIV/OB care is essential for the best treatment of a woman who is pregnant and living with HIV. 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.

A rapid test in the labor and delivery setting offers several advantages. Firstly, rapid testing identifies a woman as preliminarily HIV positive before she leaves labor and delivery. This allows for confirmatory testing and for her to be linked with care assuring appropriate follow up. Furthermore, the sooner an HIV infection is identified and a woman is linked to care the greater the chance she will have an undetectable viral load at delivery increasing the chance her baby will be HIV negative.

If possible, prenatal care for all women living with HIV should be provided by an obstetrician experienced in the care of patients with HIV. If this is not possible, physicians caring for these women should request a consultation with a physician experienced in the care of pregnant patients with HIV who can assist with mapping out an appropriate care plan for the patient.

In Illinois, any healthcare professional or hospital caring for a pregnant woman during labor or delivery is required to offer counseling and opt-out rapid HIV testing if that pregnant woman does not have a documented third trimester HIV test. Testing is not required if the pregnant woman has a documented negative HIV test from the third trimester of the current pregnancy or is already documented to be living with HIV.

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 living 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