Prenatal and Perinatal HIV Testing: ACOG Committee Opinion
Given the enormous advances in the prevention of perinatal transmission of human immunodeficiency virus (HIV), it is clear that early identification and treatment of all pregnant women with HIV is the best way to prevent neonatal infection and also improve women's health. Therefore, the American College of Obstetricians and Gynecologists (ACOG) has released a committee opinion that makes the following recommendations:

• Human immunodeficiency virus testing is recommended for all sexually active women or women who use intravenous drugs and should be a routine component of prepregnancy and prenatal care.

• Repeat HIV testing in the third trimester, preferably before 36 weeks of gestation, is recommended for pregnant women with initial negative HIV antibody tests who are known to be at high risk of acquiring HIV infection; who are receiving care in facilities that have an HIV incidence in pregnant women of at least 1 per 1,000 per year; who reside in jurisdictions with elevated HIV incidence; or who have signs or symptoms consistent with acute HIV infection (eg, fever, lymphadenopathy, skin rash, myalgias, arthralgias, headache, oral ulcers, leukopenia, thrombocytopenia, or transaminase elevation).

• Rapid screening during labor and delivery or during the immediate postpartum period using the opt-out approach should be done for women who were not tested earlier in pregnancy or whose HIV status is otherwise unknown. Results should be available 24 hours a day and within 1 hour.

• If a rapid HIV test result in labor is reactive, antiretroviral prophylaxis should be immediately initiated while waiting for supplemental test results.

• If the diagnosis of HIV infection is established, the woman should be linked into ongoing care with a specialist in HIV care for co-management.

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