Russell B Van Dyke, Susan P Danner, Sarah Chrestman, Patricia Kissinger, Steven Nesheim, Angela M Amedee, Gwendolyn Scott, Mardge H Cohen, Elaine J Abrams, Denise J Jamieson, Mary Glenn Fowler, Athena P Kourtis, Marc Bulterys and for the MIRIAD Study Group
Background: Rapid HIV testing late in pregnancy or at delivery provides a final opportunity (among non-breastfeeding mothers) to identify HIV-infected women and initiate antiretroviral drugs to prevent mother-to-child transmission.
Methods: MIRIAD was a CDC-funded study conducted from 2001-2005 at 17 hospitals in 6 US cities. Eligible women had undocumented HIV status when presenting in labor or after 34 weeks gestation and not in labor. We performed both rapid HIV-1 antibody testing of blood and conventional enzyme immunoassay with Western blot confirmation. Women and infants were managed according to the local standard of care. Infant infection status was determined by HIV DNA or RNA PCR testing.
Results: Fifty-one infants (1 pair of twins) were born to 50 women. Among those with data available, 17% of women received prenatal antiretroviral and 71% received intrapartum antiretroviral, including 64% of those identified during labor. All 49 infants with available data received antiretroviral. Forty-four infants had adequate samples to determine their infection status and 5 were infected (11.4%, 95% CI: 1.9 - 20.7%); 3 had in utero, 1 intrapartum, and 1 indeterminate timing of transmission. No infant whose mother received prenatal antiretroviral was infected. The estimated rate of intrapartum transmission among infants with defined infection status was 4.5%.
Conclusions: Rapid HIV testing late in pregnancy or even during labor, allowing the administration of antiretroviral to infected women, reduces intrapartum HIV transmission. This highlights the importance of offering rapid HIV testing to pregnant women, with unknown HIV status late in pregnancy.
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