Despite guidelines, infections remain undetected

If a pregnant woman has access to antiretroviral treatment she and her unborn child may benefit greatly from her knowledge of her HIV status early in pregnancy. Zidovudine given during pregnancy and to the infant has been shown to reduce the rate of vertical transmission from 25% to 8%.1 Furthermore, since antiretroviral therapy can produce impressive and sustained reductions in viral load, and low levels of circulating virus are associated with reduced vertical transmission2 as well as slower rates of disease progression,3 there is a strong case for early diagnosis. While mothers should always retain the right to decline an HIV test, every effort should be made to avoid undetected infection in pregnancy. To this end, the departments of health in the United Kingdom have recommended that obstetric units should offer an HIV test to all pregnant women (“universal testing”) in areas of high HIV prevalence4 5 and have provided guidance on how this should be done. Is this policy being implemented effectively?

MacDonagh and colleagues recently reported on the effectiveness …