A 19-year-old G2P1 woman at 9 weeks' gestation presents to the obstetrics and gynaecology clinic for her second prenatal visit. She reports no complaints other than occasional nausea. She had her first child by spontaneous vaginal delivery without complications. She is taking no medications and denies ethanol, tobacco, or current drug use. While she does admit to a history of intravenous drug abuse, she denies using them since the birth of her first child. Over the past several months she has had multiple sexual partners and does not use contraception. On physical examination she is in no acute distress. Lungs are clear to auscultation bilaterally. Her heart has a regular rate and rhythm, with no murmurs, rubs, or gallops. She is informed that she will need the routine prenatal tests, including an HIV test. The physician informs her of the risks and benefits of the HIV test.1What else should the physician inform the patient before performing the test:
The CDC and ACOG (2008) has recommended prenatal screening for HIV using an “optout approach” this means that the woman is notified that HIV testing is included in a comprehensive set of antenatal tests, but that testing may be declined.
Women are given information regarding HIV but are not required to sign a specific consent.
Screening is performed using an ELISA test which has a sensitivity of > 99.5%
A positive test is confirmed with either a western blot or immunofluorence assay (IIFA) both of which have high specificity.
According to CDC, antibody can be detected in most patients within 1 month of infection and thus antibody serotesting may not exclude early infection.
Despite the potential for fetal infection , she may opt out from the test
Early retroviral therapy will absolutely decrease the chances of transmitting infection to the baby.
CDC recommends screening only for patients with high risk factors
Risk of the test include potential for fetal loss.