Perinatal Screening of HIV
April 15, 2000 2 minutes read
Updates By Carol A. Kemper, MD, FACP
Perinatal Screening of HIV
Source: Van Tine BA, et al. N Engl J Med 1999;341:1548.
A two-month-old girl was ad-mitted to the hospital with failure to thrive following a pregnancy complicated by syphilis during the first trimester. Consistent with the current guidelines to screen all pregnant women for HIV infection as soon as the pregnancy is identified, the mom had tested negative for HIV by EIA during the first trimester, along with three of her partners. The work-up for failure to thrive was unremarkable. Of note, tests for HIV antibodies on cord blood, on admission, and seven weeks later were negative. The baby continued to do poorly, and by the eighth week of admission developed severe lymphopenia and respiratory failure and died. Autopsy revealed P. carinii pneumonia and disseminated CMV infection. Tests for HIV antibody remained negative, but plasma p24 antigen was positive and an HIV RNA was 3.2 million copies per mL. Although the mother denied any symptoms suggestive of primary HIV infection during pregnancy, subsequent HIV tests were positive.
Rapidly progressive seronegative HIV disease rarely occurs in infants and can be misleading, especially if screening blood tests on the mom are also negative. However, as this unfortunate case points out, screening for HIV infection during the earliest part of the pregnancy may miss women with acute primary HIV infection who may be in the "window period" or those who acquire HIV later during their pregnancy. Consideration should be given to repeated screening for pregnant women at high risk for HIV, including the use of assays for direct detection of virus.
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