Single HIV screening in early pregnancy inadequate —Scientists

In a study, researchers say routine HIV retesting in labour for pregnant women to identify new infections is important following their finding that 3.7 per cent of infants whose mothers seroconverted during pregnancy were infected with HIV.

This study evaluated the HIV seropositivity in labour among pregnant women who earlier tested negative in the antenatal clinic, as well as associated risk factors and the corresponding rate of mother-to-child transmission of HIV infection.

This was a prospective observational study where pregnant women in labour who had earlier tested HIV-negative in the antenatal clinic at Imo State University Teaching Hospital Orlu, Imo State, Nigeria, were retested. It was in the 2019 edition of the Nigerian Journal of Clinical Practice.

The infants of the women who seroconverted were tested for HIV infection at six weeks using Deoxyribonucleic acid polymerase chain reaction (DNA PCR) by collecting dried blood sample.

This study was conducted from October 2015 to March 2016.

Out of the 163 patients studied, six demonstrated HIV seroconversion giving a seroconversion rate of 3.7 per cent. All the five live babies tested HIV negative at six weeks of age.

Age range 20 to 24 accounted for the highest repeat HIV seroconversion rate and predictors of seroconversion in late pregnancy include marital status, multiple sexual partners and past history of sexually transmitted diseases.

Others are the partners’ HIV status and the number of other sexual partners.

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Blood transfusion, alcohol intake, anal sex and use of barrier method of contraception was not significantly associated with increased repeat HIV seroconversion rate.

The researchers said the high repeat HIV seroprevalence is unacceptable because it implies that for every 27 women that test HIV negative early in the antenatal period, one woman would likely turn positive in late pregnancy.

According to them, a single HIV screening in early pregnancy for antenatal attendees is inadequate and definitely leads to true missed prevention opportunity because these women had availed themselves of antenatal care and testing.

Several studies have stressed the need for a retest later in pregnancy to identify seroconverters, bearing in mind the fact that women who test negative in early pregnancy remain at risk of acquiring HIV, and also the fact that the risk of transmission to the infant is very high with new infections.

In reducing the number of new HIV infections among children, they declared that retesting of HIV negative pregnant women in labour to identify new infections and instituting appropriate modified obstetrics practices (MOP) has a huge role to play.

According to them, further studies to determine the reasons for seroconversion will be of the immense value so that cost-effective preventive measures will be applied especially in developing countries with very high disease burden.