Preventing Perinatal HIV Transmission Newsletter: Field Update Banner Logo

Overview

Welcome to this issue of Preventing Perinatal HIV Transmission: Field Update. You are receiving this newsletter because you expressed an interest in perinatal HIV prevention in hospitals or have signed up to receive it. This free quarterly email newsletter connects its subscribers to news updates, trends, statistics, prevention programs, policy initiatives, tools, and useful practices relating to perinatal HIV prevention in U.S. hospitals.  The Health Research and Educational Trust (HRET), with support from the Centers for Disease Control and Prevention (CDC), produces this newsletter as a forum for information dissemination and for communication among and between hospital staff, HIV experts, and researchers.  

 

For more information on HRET’s Perinatal HIV Prevention project, please visit our website.

 

If you have comments or suggestions for future issues of this newsletter, please contact Jennifer Reiter at jreiter2@aha.org.

 

CDC Responds to Concerns on Testing for Confirmation of Reactive Oral Fluid Rapid HIV Antibody Tests
In March 2004, the FDA approved the OraQuick® Rapid HIV-1 Antibody Test for use with oral fluid by trained personnel as a point-of-care test to aid in the diagnosis of HIV.  In June 2004, the FDA approved an added claim for detection of HIV-2 antibodies in oral fluid and a change in the name of the device to OraQuick® Advance Rapid HIV-1/2 Antibody Test.

 

A reactive rapid HIV test result is considered preliminary and must be confirmed by supplemental testing.  Some false positive rapid test results (i.e., reactive rapid test results followed by negative supplemental test results) are to be expected within the range of specificity for the device. However, in late 2005, HIV testing programs in multiple U.S. cities experienced apparent clusters of false-positive rapid HIV test results using oral fluid (but not whole blood) specimens. Counselors at these programs have expressed concern regarding the specificity and positive predictive value of the oral fluid rapid HIV test. The published sensitivity and specificity for the test using oral fluid are 99.3% (95% confidence interval [CI] = 98.4%--99.7%) and 99.8% (CI = 99.6%--99.9%), respectively. CDC has received multiple inquiries concerning whether its guidelines for confirmatory testing for reactive rapid HIV tests on oral fluid specimens have been modified.

 

CDC is actively working with FDA, state and local health officials, and the product manufacturer to investigate these reports, assess the test's current performance, and consider whether changes in testing protocols should be recommended or any other actions taken. In the meantime, current protocols for confirmation of reactive rapid HIV test results should continue to be followed. These protocols ensure that clients with reactive rapid test results receive accurate HIV test results after confirmation. HIV counselors returning reactive (preliminary positive) results from HIV rapid tests to clients should provide the same counseling message that is currently recommended, regardless of whether the reactive test result was obtained using oral fluid or whole blood. HIV testing program directors who have noted any problems or who have concerns over the performance of the OraQuick Advance Rapid HIV-1/2 Antibody Test in their particular settings should report these concerns to OraSure Technologies at telephone 800-672-7873.

 

Illinois’ House Committee Approves Bill that would Mandate HIV Testing for Infants Born to Untested Women
In January, the Illinois House Human Services Committee approved 9-3 a bill (HB 4306) that would mandate HIV testing of infants born to untested women unless a parent or guardian objects on religious grounds.  Since August 2004, Illinois has required hospitals and clinics to counsel pregnant women about HIV and offer to test them via blood.  As a result, the number of pregnant women who know their HIV status before they leave the hospital has significantly increased from 72% to 98%.  The state's current law requires any pregnant woman who decides to be tested to sign an informed consent form before undergoing the test.  Infants born to women whose HIV status is unknown are also automatically tested for the virus unless the mother signs a form to opt out of testing of her infant.  Under the proposed bill, infants would automatically be tested regardless of parental consent unless a parent or guardian submits a written form to the physician that the test "conflicts with his or her religious tenets and practices."

 

Archived: CDC Satellite Broadcast/Web cast on Revised Recommendations for HIV Screening
CDC and the Public Health Training Network presented a satellite broadcast and Web cast, "Revised Recommendations for HIV Screening of Adults, Adolescents and Pregnant Women in Health Care Settings," on November 17, 2005.  The 2-hour forum covered the rationale for expanded HIV screening in health care settings, alternative procedures for normalizing screening in various health care settings, and practices that facilitate routine screening

 

The archived broadcast can be viewed on computers with Internet and RealPlayer® capability here. Videotapes and video CD-ROMs of the broadcast can be ordered by telephone at 800-458-5231.

 

Updated ACIP Recommendations on Perinatal and Childhood Hepatatis B Prevention

The Advisory Committee on Immunization Practices (ACIP) recently released updated recommendations on preventing perinatal and childhood hepatitis B virus transmission.  These recommendations are designed for prenatal care providers, delivery hospitals, and health departments.  The ACIP now recommends that, except on a case-by-case basis and only in rare circumstances, universal infant hepatitis B vaccination should begin at birth.  To access the revised recommendations, please do so through the CDC's Morbidity and Mortality Weekly Report.

 

To further publicize these recommendations, there will be a CME-accredited phone and web conference on Thursday, February 2 from 12-1pm EST.  The conference will be downloadable here after its broadcast.  

 

Texas Department of State Health Services Publishes Booklet on Sex, Pregnancy, and HIV

Four Sisters, Four Stories, a new educational booklet about preventing perinatal HIV infection, has been completed and is now ready for distribution to HIV/STD service providers.  The primary target audience of this booklet is women of childbearing age with HIV infection or who are at risk for HIV infection.  The stories in the booklet are based on interviews conducted with HIV-infected women of childbearing age in East Texas.  The booklet also includes a list of frequently asked questions and other information about pregnancy, HIV, and other STDs. 

 

To order this booklet, please contact the DSHS warehouse at 512-458-7761 or visit their web site. 

 

Profiles on Successful Perinatal HIV Prevention Programs

One of HRET’s national collaborative partners, CityMatCH, has developed a document that profiles the successful perinatal HIV prevention programs implemented by the urban communities they have been working with over the past several years.  This compendium of best practices, Profiles of Perinatal HIV Prevention, is available on CityMatCH’s website under the “Perinatal HIV Prevention” section on the right-hand side.  For more information about these programs or to inquire about limited quantities of print copies of this document, please contact Chad Abresch at cabresch@unmc.edu

 

New Legislative Toolkit from ACOG on HIV Testing of Pregnant Women

The American College of Obstetricians and Gynecologists (ACOG) has developed a legislative toolkit regarding HIV testing of pregnant women.  This binder of valuable information includes:

  • suggested language for a perinatal HIV testing law that is consistent with published recommendations;
  • the November 2004 ACOG guidance on perinatal HIV testing; and
  • a selection of other guidelines and recommendations (for example, from the Institute of Medicine and CDC).

This toolkit is primarily designed for legislators to use when crafting new or revised perinatal HIV legislation.  However, this resource also will be very valuable to public health professionals when communicating with lawmakers about drafting and promoting perinatal HIV legislation. These materials will help lawmakers and MCH advocates/lobbyists understand the history and issues surrounding perinatal HIV transmission, current testing recommendations, and the benefits of the opt-out testing approach.  To obtain a copy of this toolkit by mail or to get more detailed information that is specific to the laws in your state or jurisdiction, please contact Becky Carlson at rcarlson@acog.org.

 

CDC HIV Web Site Update

CDC has completed posting information from their June 2005 HIV meeting on their website.  Nearly all the presentations given at the meeting are available on the website, as well as the “Promising Practices” submitted by each grantee state.  All of these materials can be viewed on the CDC public perinatal website

 

NEJM Article on Planned Pregnancy and HIV

In the October 20, 2005, edition of the New England Journal of Medicine, an article about an HIV-positive woman’s desire to become pregnant was published.  This article examined one woman’s pregnancy, from her initial planning check-ups with her doctor, all the way through her labor and delivery, along with the many medical treatments she received throughout her prenatal months.  Treatment and monitoring of her newborn, whose viral load remained undetectable after six months, is also discussed.  To access the full article, click here.

 

New Study Says that Infants Born to HIV-Positive Women With Herpes are More Likely to Contract HIV

Infants born to HIV-positive women diagnosed with genital herpes during pregnancy are more likely to contract HIV, according to a study published in the December 2005 issue of Obstetrics and Gynecology.  Between 1994 and 1999 in New York City, Katherine Chen of Columbia University and colleagues looked at 402 HIV-positive pregnant women.  Researchers found that of the 21 women diagnosed with genital herpes during pregnancy, 6 gave birth to an HIV-positive infant.  The researchers accounted for other factors that can contribute to mother-to-child HIV transmission and found that genital herpes infection raised the risk of mother-to-child-transmission nearly five fold. According to the researchers, factors such as a lack of antiretroviral treatment during pregnancy or labor, rupture of membranes, and pre-term delivery also put infants born to HIV-positive women with genital herpes at an higher risk of contracting HIV.  However, Chen noted that more studies need to be carried out to confirm the findings. She added that it still needs to be determined if HIV-positive women with current or prior histories of genital herpes should receive herpes treatment through pregnancy to prevent vertical HIV and herpes transmission. Chen and colleagues are currently conducting a trial to analyze HIV and genital herpes viral levels among HIV-positive women.

 

Study Finds that Small Tears in Placenta are Likely Associated With Mother-To-Child HIV Transmission

According to a study published this past November in PLoS Medicine, small tears in the placenta of HIV-positive pregnant women might allow the virus to pass from the woman's blood to the infant during delivery and could play a role in mother-to-child transmission.  In 2003, Steven Meshnick, a professor of epidemiology at the University of North Carolina-Chapel Hill School of Public Health, and colleagues examined 149 pregnant, HIV-positive women in Malawi.  Each woman received one dose of an antiretroviral drug to reduce the risk of vertical HIV transmission.  Researchers then measured the amount of a placental protein - which normally is too large to pass through the placenta - in the umbilical cord blood of each woman.  The researchers found that infants had a higher risk of HIV infection when there was more placental protein in the umbilical cord blood.  They said that HIV transmission could happen during labor when contractions occur, rather than when the infant is in the birth canal.  Meshnick confirmed that his study’s new data are consistent with the finding that HIV-infected women who undergo caesarean section before they go into labor do not transmit the virus, whereas those who undergo emergency c-sections after they go into labor do transmit it.

 

New HIV and AIDS Journal in Current Opinion Journal Series

To kick-start the new year, a new publication titled Current Opinion in HIV and AIDS was launched.  Published by Lippincott Williams & Wilkins, six editions of the journal will be published annually. The journal presents analysis and examination by leading experts of significant research developments involving HIV/AIDS.

 

Each bimonthly issue features guest editors who focus specifically on topics in their specialty. In addition, Current Opinion in HIV and AIDS publishes expert assessments of developments from the previous year. Editorials and invited reviews cover key subjects such as the T-Cell in HIV infection and disease, reservoirs, host factors, HIV vaccines, anti-retro viral therapy, and clinical trial design.

 

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