Maternal HIV Testing and Identification of Perinatal HIV Exposure
Last Updated: April 16, 2019; Last Reviewed: April 16, 2019
Panel's Recommendations for Maternal Testing and Identification of Perinatal HIV Exposure
- HIV testing is recommended as standard of care for all sexually active women and should be a routine component of preconception care (AII).
- All pregnant women should be tested as early as possible during each pregnancy (see Laboratory Testing for the Diagnosis of HIV Infection: Updated Recommendations and Recommended Laboratory HIV Testing Algorithm for Serum or Plasma Specimens) (AII).
- Partners of pregnant women should be encouraged to undergo HIV testing when their status is unknown (AIII).
- Repeat HIV testing in the third trimester is recommended for pregnant women with negative initial HIV antibody tests who are at increased risk of acquiring HIV, including those who are receiving care in facilities that have an HIV incidence of ≥1 case per 1,000 pregnant women per year, those who reside in jurisdictions with elevated HIV incidence, or those who reside in states that require third-trimester testing (see Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings (AII).
- Expedited HIV testing at the time of labor or delivery should be performed for any woman with undocumented HIV status; testing should be available 24 hours a day, and results should be available within 1 hour (AII). If results are positive, intrapartum antiretroviral (ARV) prophylaxis should be initiated immediately (AI), and infants should receive an ARV regimen that is appropriate for infants who are at higher risk of perinatal HIV transmission as soon as possible, pending results of supplemental HIV testing (AII). See Antiretroviral Management of Newborns with Perinatal HIV Exposure or Perinatal HIV for guidance.
- Women who have not been tested for HIV before or during labor should undergo expedited HIV antibody testing during the immediate postpartum period (or their newborns should undergo expedited HIV antibody testing) (AII). If the results for the mother or infant are positive, an appropriate infant ARV drug regimen should be initiated immediately, and the mother should not breastfeed unless supplemental HIV testing is negative (AII). Infants with initial positive HIV viral tests (RNA, DNA) should have their ARV regimen modified, if necessary, to a three-drug combination of ARV drugs at treatment doses (see Antiretroviral Management of Newborns with Perinatal HIV Exposure or Perinatal HIV) (AII).
- Results of maternal HIV testing should be documented in the newborn’s medical record and communicated to the newborn’s primary care provider (AIII).
- HIV testing to determine HIV status is recommended for infants and children in foster care and adoptees for whom maternal HIV status is unknown (AIII).