Saunders Sarah, Tulloch Karen, Maan Evelyn J, van Schalkwyk Julianne, Money Deborah M
University of British Columbia, Vancouver, BC.
Oak Tree Clinic, BC Women's Hospital and Health Centre, Vancouver, BC.
J Obstet Gynaecol Can. 2017 Aug;39(8):668-675. doi: 10.1016/j.jogc.2017.02.016.
This study was conducted to evaluate the roll-out of rapid HIV testing as part of an emergency Prevention of Perinatal HIV Transmission Program. Specifically, HIV prevalence in this population, the reason(s) for performing the rapid HIV test, and compliance with recommendations for antiretroviral prophylaxis were assessed.
Since November 2011, all women presenting to a tertiary labour and delivery unit with unknown HIV status or with ongoing risk of HIV infection since their last HIV test were offered rapid HIV testing. Through retrospective chart review, demographic data, HIV risk and prior testing history, and antiretroviral prophylaxis, data were collected and descriptive statistics were performed.
One hundred fourteen rapid HIV tests were conducted and there were two preliminary reactive rapid results (one true positive, one false positive). None of the infants was HIV infected. Sixty-three percent of women had multiple risk factors for HIV acquisition, most commonly intravenous drug use (54%). Forty-four percent of women were within the 4-week seroconversion window at the time of delivery; 25% of these women and 52% of their infants received prophylactic drug therapy.
Rapid HIV testing identified a high-risk cohort and enabled aggressive management of a newly diagnosed HIV-positive pregnancy, successfully preventing perinatal HIV transmission. Risk factors for HIV acquisition were ongoing within the seroconversion window for over half of the women, impacting the utility of the test in eliminating unnecessary antiretroviral prophylaxis in this population because prophylaxis is recommended despite a negative rapid HIV test in these cases.
本研究旨在评估作为紧急预防围产期HIV传播项目一部分的快速HIV检测的推广情况。具体而言，评估了该人群中的HIV流行率、进行快速HIV检测的原因以及对抗逆转录病毒预防建议的依从性。
自2011年11月起，所有前往三级产科和分娩科室、HIV感染状况不明或自上次HIV检测后仍有HIV感染风险的女性均接受了快速HIV检测。通过回顾性病历审查，收集了人口统计学数据、HIV风险和既往检测史以及抗逆转录病毒预防情况的数据，并进行了描述性统计分析。
共进行了114次快速HIV检测，有2次初步反应性快速检测结果（1次真阳性，1次假阳性）。没有婴儿感染HIV。63%的女性有多种感染HIV的风险因素，最常见的是静脉吸毒（54%）。44%的女性在分娩时处于4周血清转化窗口期；这些女性中有25%及其婴儿中的52%接受了预防性药物治疗。
快速HIV检测识别出了一个高危队列，并能够对新诊断出的HIV阳性妊娠进行积极管理，成功预防了围产期HIV传播。超过一半的女性在血清转化窗口期内仍存在感染HIV的风险因素，这影响了该检测在消除该人群中不必要的抗逆转录病毒预防措施方面的效用，因为在这些情况下，尽管快速HIV检测结果为阴性，但仍建议进行预防。
