Rapid Diagnostic Testing for HIV:
Clinical Implications of a New Diagnostic Tool

RECOMMENDATIONS FOR RAPID HIV TESTING
OF WOMEN IN LABOR

Prevention of vertical HIV transmission has been an important success story in the HIV pandemic. The risk of transmission has been reduced from approximately 25% to less than 2% by using currently recommended obstetrical interventions and prenatal combination antiretroviral therapy in women aware of their HIV infection early in pregnancy.¹⁰ In New Jersey, the perinatal transmission rate has decreased from 21% in 1991 to less than 4% in 2004.⁵

In New Jersey, regulations require that all pregnant women receive counseling and be offered a voluntary HIV test.¹² Ideally all pregnant women should be offered HIV testing during an initial prenatal visit, to allow for timely initiation of treatment to reduce the chance of vertical transmission. However, a particular area of concern is women who present in labor with unknown HIV status (HIV test results not documented on the medical record). These women may not have been offered HIV counseling and testing during pregnancy, may have opted not to have an HIV test during pregnancy, or may not have received prenatal care. Clinical trial data have shown that antiretroviral medications, even when started during labor and delivery and continued in the neonatal period, can reduce mother-to-child HIV transmission by up to fifty percent.^13,14,15

When women present in labor with unknown HIV status, the key to maximal perinatal HIV risk reduction is rapid HIV testing and initiation of short course therapy. The CDC sponsored Mother-Infant Rapid Intervention at Delivery (MIRIAD) study showed that offering voluntary HIV testing during labor is feasible in obstetrical settings. In addition, point-of-care testing has been shown to provide results faster than sending specimens to the hospital laboratory for rapid HIV testing.¹⁶ The CDC recommends rapid HIV testing for women in labor whose HIV status is unknown.¹⁷

The NJDHSS has established a standard of care in which women who present in labor with unknown HIV status should receive counseling, be offered voluntary rapid HIV testing, and if a preliminary positive rapid HIV test result is obtained; be offered short course therapy with referral to a physician with experience and expertise treating HIV disease for both the mother and the child.¹² The “Public Health Service Task Force Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV-1 Transmission in the United States - June 23, 2004” describes four options for short course therapy.¹³