Catalogue


Screening for HIV in pregnant women [electronic resource] : systematic review to update the U.S. preventive services task force recommendation /
prepared for, Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by, Oregon Evidence-based Practice Center, Oregon Health & Science University ; investigators, Roger Chou ... [et al.].
imprint
Rockville, MD : Agency for Healthcare Research and Quality, [2012]
description
1 online resource (PDF file (vi, 99 p.))
format(s)
Book
Holdings
More Details
added author
imprint
Rockville, MD : Agency for Healthcare Research and Quality, [2012]
restrictions
Licensed for access by U. of T. users.
general note
"Contract No. HHSA-290-2007-10057-I, Task Order No. 8".
"November 2012."
abstract
BACKGROUND: A 2005 U.S. Preventive Services Task Force (USPSTF) review found good evidence that prenatal HIV screening is accurate and can lead to interventions that reduce the risk of mother-to-child transmission. PURPOSE: To systematically update the 2005 USPSTF review on benefits and harms of prenatal HIV screening, focusing on research gaps previously identified and new evidence on treatments. DATA SOURCES: We searched MEDLINE (2004 to June 2012) and the Cochrane Library Database (2005 to the second quarter of 2012) and manually reviewed reference lists. STUDY SELECTION: We selected randomized trials and cohort studies of pregnant women that reported risk of mother-to-child transmission or maternal or infant harms associated with prenatal HIV screening or antiretroviral therapy during pregnancy. We also selected studies that reported the yield of repeat prenatal screening or the positive predictive values and harms associated with rapid versus standard HIV testing during pregnancy. DATA EXTRACTION: Two reviewers abstracted and confirmed study details and quality using predefined criteria, based on methods developed by the USPSTF. DATA SYNTHESIS (RESULTS): No study directly evaluated effects of prenatal screening for HIV infection versus no screening on risk of mother-to-child transmission or maternal or infant clinical outcomes. One fair-quality, large cohort study (0.7% HIV prevalence) found rapid testing during labor associated with a positive predictive value of 90 percent. New cohort studies of nonbreastfeeding women in the United States and Europe confirm that full-course combination antiretroviral therapy reduces risk of mother-to-child transmission (<1% to 2.4% vs. 9% to 22% with no antiretroviral therapy). New cohort studies found antiretroviral therapy during pregnancy associated with increased risk of preterm (prior to 37 weeks' gestation) delivery, with no clear association with low birth weight, congenital abnormalities, or infant neurodevelopment. Although some studies found an association between in utero exposure to antiretroviral therapy and subsequent echocardiographic abnormalities, hematologic abnormalities, and markers of mitochondrial dysfunction, the clinical significance of these findings remains unclear. Evidence on long-term maternal harms associated with short-term exposure to antiretroviral therapy during pregnancy, or antiretroviral therapy started during pregnancy and continued after pregnancy, remains sparse. LIMITATIONS: Only English-language articles were included. Due to limited evidence from randomized trials, we included cohort studies of treatments. Studies conducted in resource-poor settings may be of limited applicability to screening in the United States. CONCLUSIONS: Antiretroviral therapy in combination with avoidance of breastfeeding and elective Cesarean delivery in women with viremia reduces risk of mother-to-child transmission. Use of certain antiretroviral therapy regimens during pregnancy may increase risk of preterm delivery, but more evidence is needed to fully understand short- and long-term maternal and infant effects.
catalogue key
9069541
 
Includes bibliographical references.
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, 540 Gaither Road, Rockville, MD 20850; www.ahrq.gov Contract No. HHSA-290-2007-10057-I, Task Order No. 8, Prepared by: Oregon Evidence-based Practice Center, Oregon Health & Science University 3181 SW Sam Jackson Park Road, Portland, OR 97239; www.ohsu.edu/epc

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