Maternal HIV Testing and Identification of Perinatal HIV Exposure
Last Updated: November 15, 2017; Last Reviewed: November 15, 2017
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 HIV-negative women in the United States should be tested as early as possible during each pregnancy (AII).
- Repeat HIV testing in the third trimester is recommended for pregnant women with initial negative HIV antibody tests who are known to be at risk of acquiring HIV, who are receiving care in facilities that have an HIV incidence in pregnant women of at least 1 per 1,000 per year, who are incarcerated, or who reside in jurisdictions with elevated HIV incidence (see Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings and https://stacks.cdc.gov/view/cdc/23447) (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 available within 1 hour (AII). If results are positive, intrapartum and infant postnatal antiretroviral (ARV) drug prophylaxis should be initiated immediately, pending results of supplemental HIV testing (AII) see Perinatal Guidelines 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 results in mother or infant are positive, an appropriate infant antiretroviral (ARV) drug regimen should be initiated immediately, and the mothers 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 dosages (antiretroviral therapy) (see Antiretroviral Management of Exposed Infants) (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).
|Rating of Recommendations: A = Strong; B = Moderate; C = Optional
Rating of Evidence: I = One or more randomized trials in children† with clinical outcomes and/or validated endpoints; I* = One or more randomized trials in adults with clinical outcomes and/or validated laboratory endpoints with accompanying data in children† from one or more well-designed, nonrandomized trials or observational cohort studies with long-term clinical outcomes; II = One or more well-designed, nonrandomized trials or observational cohort studies in children† with long-term outcomes; II* = One or more well-designed, nonrandomized trials or observational studies in adults with long-term clinical outcomes with accompanying data in children† from one or more similar nonrandomized trials or cohort studies with clinical outcome data; III = Expert opinion
† Studies that include children or children and adolescents, but not studies limited to post-pubertal adolescents