Screening for HIV in pregnant women: systematic review to update the 2005 U.S. Preventive Services Task Force recommendation.

BACKGROUND A 2005 U.S. Preventive Services Task Force (USPSTF) review found good evidence that prenatal HIV screening is accurate and can lead to interventions that reduce the risk for mother-to-child transmission. PURPOSE To update the 2005 USPSTF review, focusing on previously identified research gaps and new evidence on treatments. DATA SOURCES MEDLINE (2004 to June 2012) and the Cochrane Library (2005 to the second quarter of 2012). STUDY SELECTION Randomized trials and cohort studies of pregnant women on risk for mother-to-child transmission or harms associated with prenatal HIV screening or antiretroviral therapy during pregnancy. DATA EXTRACTION 2 reviewers abstracted and confirmed study details and quality by using predefined criteria. DATA SYNTHESIS No studies directly evaluated effects of prenatal HIV screening on risk for mother-to-child transmission or maternal or infant clinical outcomes. One fair-quality, large cohort study (HIV prevalence, 0.7%) found that rapid testing during labor was associated with a positive predictive value of 90%. New cohort studies of nonbreastfeeding women in the United States and Europe confirm that full-course combination antiretroviral therapy reduces rates of mother-to-child transmission (<1% to 2.4% vs. 9% to 22% with no antiretroviral therapy). New cohort studies found antiretroviral therapy during pregnancy to be associated with increased risk for preterm delivery (<37 weeks' gestation); there were no clear associations with low birthweight, congenital abnormalities, or infant neurodevelopment. Evidence on long-term maternal harms after short-term antiretroviral therapy exposure during pregnancy remains sparse. LIMITATIONS Only English-language articles were included. Studies conducted in resource-poor settings may be of limited applicability to screening in the United States. CONCLUSION Antiretroviral therapy in combination with avoidance of breastfeeding and elective cesarean section in women with viremia reduces risk for mother-to-child transmission. Use of certain antiretroviral therapy regimens during pregnancy may increase risk for preterm delivery. PRIMARY FUNDING SOURCE Agency for Healthcare Research and Quality.