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HIV Testing In Pregnancy - Gauging Risks Of Transmission Of The HIV Virus Into The Baby

On your first prenatal visit, you’ll typically provide blood and urine samples for a variety of tests. One test that you’ll likely be asked to consent to is a test for HIV. And although this test provides some helpful information, you should never feel that you’re being coerced to take an HIV test and you should always be offered counseling whether or not you take the test and whatever the result may be.

An HIV blood test looks for the presence of antibodies to HIV, which is short for human immunodeficiency virus. If you test positive for HIV, it doesn’t mean that you have the acquired immunodeficiency syndrome (AIDS) or that you’ll necessarily develop AIDS. If your initial screening blood test results are positive or inconclusive, additional confirmatory testing is usually performed.

There are several reasons that an HIV test can be a false positive. For example, these include having received a blood transfusion, having liver disease, having an autoimmune disease such as lupus, or having recently received an immunization against rabies, influenza, or Hepatitis B. Pregnancy can also cause a false positive result, particularly multiple pregnancies. For this reason, if you test positive for HIV during your pregnancy, you should always request an additional test for confirmation – specifically the Western Blot test, which is the most accurate test available as of this writing.

If a mother-to-be tests positive for HIV, the concern is that she may transmit the HIV infection to her unborn child. This is less likely to happen during pregnancy than it is during labor and delivery, when the baby may be exposed to the mother's blood, or during breastfeeding, when the baby may receive the HIV virus in his mother's breast milk. A woman considered to be at risk, who has not received previous testing can be given or request a rapid HIV test during delivery – some tests provide results in as little as 15 minute.

If a woman tests positive for an HIV infection, then the usual course of action is for her to receive HIV medications – typically, the medication azidothymidine (AZT), either alone or in a multi-drug “cocktail,” during her pregnancy, labor and delivery. In addition, she and her baby will continue to receive medication for a period of about one year after the baby is born.

Women who test positive for HIV will give birth to babies who test positive for HIV antibodies. However, this doesn’t mean that the baby has an HIV infection. It takes from 6 to 18 months to get a reliable test result when testing an infant, and overall, there’s thought to be a 25% chance that an HIV positive mother will infect her infant with the HIV virus in the absence of any treatment and during a vaginal birth. If the mother is on medication, this risk is usually reduced to about 8%, and the risk is also thought to be lower if a Cesarean section is performed before the amniotic sac ruptures. However, research has found that women who are deficient in vitamin A are more likely to pass the virus on to their babies, and that women who receive optimal amounts of vitamin A are only 7% likely to pass the virus on to their babies.

Of course, this testing procedure and subject come with quite a bit of controversy. If a mother is HIV positive, should she subject herself and her unborn child to medication which has not been proven safe for use during pregnancy and allow her newborn to receive medication that has not been FDA approved for use in newborns? Or is reducing the risk of transmitting HIV to her baby worth the risk the treatment brings with it? It is widely believed that medical research will have better answers to offer us in the future, but until then, this remains a very personal and complex dilemma, one that all parents must answer for themselves.

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