HIV Study Advocates Universal Testing

HIV testing for pregnant women should be routine and universal, a report released by the Institute of Medicine (IOM) said last week.

The IOM committee that compiled the report was chaired by Marie C. McCormick, chair of the department of maternal and child health at the Harvard School of Public Health.

According to the report, early identification and treatment of HIV-infected pregnant women have resulted in a 43 percent drop in new pediatric AIDS cases between 1992 and 1996.

The report, mandated by the federal government, measures progress in reducing prenatal transmission of HIV. Congress asked the states to provide routine HIV counseling and voluntary testing of pregnant women in 1996.

Congress's request came in reaction to the findings of a 1994 trial of AZT, a drug that reduces transmission of HIV to babies by two-thirds.

Since then, the greatest barrier to implementing routine testing has been the counseling requirement, McCormick said.

"Doctors didn't always follow through on the testing because of the counseling requirement," she said. "We found a 50 percent reduction in prenatal transmission which could have been...95 percent."

McCormick said the counseling should be flexible.

"It should depend on clinical judgment; whether it is clinically useful. But in a public health screening program like this, the doctor should know what to say if the patient tests positive," she said. "We must also consider the fact that people are much more informed about AIDS than ever before."

But critics of the report say that because a positive result can trigger emotional distress, counseling should be required before HIV testing.

Critics of the study also say that the risk of emotional stress caused by false-positives must also be considered.

According to the committee, however, the testing procedure ensures a very low rate of false-positives. In this procedure, blood is tested for antibodies. If the results are positive, the same blood specimen is tested again. If positive for a second time, doctors perform a "very sensitive" PCR amplification test, McCormick said.

The committee hopes the test will become a standard practice, reducing its stigma.

"Given current therapy, one can almost eliminate transmission of HIV to babies. To miss that opportunity would be a crime," McCormick said.