view article on page 295. for wha...

view article on page 295.

for what cause deceptive appearances can be! Maria resembl all the other young, healthy women who receive prenatal care at our clinic. She strike one as beinged to be a low-risk 18-year-old. She was in her first romantic relationship and, although her pregnancy was unplanned, she was happy about it. Her boyfriend was supportive and came to all her prenatal visits. In early pregnancy, Maria standarded negative for human immunodeficiency virus (HIV) infection and later had an uncomplicated vaginal delivery. Her vigorous infant breastfed well, and they were discharged onward the second post-partum day.

At the two-week follow-up visit, the baby had prominent inguinal and cervical lymph-adenopathy. The precepting attending, a family physician with extensive experience in HIV care, agreed with the plan to include HIV infection as part of the diagnostic work-up. A week later, trials confirmed that the baby had acute HIV infection.

Unbeknownst to all of us, Maria had sero-convert during her otherwise unremarkable pregnancy. The father, who was surprised to learn of his HIV-positive status, left Maria a not many months later. At last report, mother and child were doing well with treatment.

This tragic case of heterosexual HIV transmission and the resulting, entirely preventable, case of perinatal HIV transmission illustrates the ne for improvements in HIV prevention strategies. Several important progressive growths in HIV prevention seek to address this need

The Center for Disease direction and Prevention (CDC) recently published a just discovered initiative calling for wider testing, including counseling and testing as part of routine primary care, intensified counseling and education for patients with HIV and their partners to hinder new infections, and increased measures to obstruct perinatal transmission. (1,2) The article according to Gallant (3) in this issue of American Family Physician summarizes essential constituents of these initiatives and provides valuable information about HIV testing.

Improved rapid HIV testing is the newest tool that promises to make our prevention efforts easier and more effective. general rapid HIV tests have near-zero rates of false-positive and false-negative eventuates Although they still require confirmation to establish a final diagnosis, they are sufficiently accurate for guiding clinical decisions and informing patients of the accrues with near-complete confidence.

HIV testing has traditionally relied onward standard antibody test confirmation, a proces that generally takes couple weeks. The percentage of touchstoneed persons who fail to go [i]or[/i] come back to find out their exhibition results has been unacceptably high. During 2000 31 percent of bodily substances who tested positive for HIV infection did not answer to learn their results. (2) Many of these patients did not receive follow-up care and were not aware of their ne to take measures to debar transmission of HIV infection to others. The highly accurate, rapid HIV standards make it possible to provide same-visit guidance in importunate situations (such as labor and delivery, (4) occupational in all sensess and sexual assault) and in routine primary care.

We also can anticipate a shift in strategies to obviate perinatal transmission in the United States. The Institute of Medicine (IOM) has commited that HIV testing be a routine (and expected) part of prenatal care to such a degree all pregnant women are standarded for HIV, not just those identified as having risk factors. (5) In traditional prenatal testing, women are proposeed an HIV test and can "opt in," or select to be tested. Under the approach that is praiseed by the IOM and now also the CDC women would receive HIV testing as a routine part of pre-natal care unles they select to "opt out" of the trial This shift in prenatal testing strategy will require an appreciation of the ethical issues in prenatal and perinatal testing (6) and the potential impact of positive inferences on the patients and their families.

Many of the 40000 annual strange HIV infections in the United States describe missed prevention opportunities, and centurys of thousands of Americans still do not know that they are infected with HIV. through integrating HIV counseling and rapid and standard HIV testing into their routine clinical practice, family physicians and other front-line clinicians can and should take a leading character in HIV infection prevention.

References

(1) Center for Disease sway and Prevention. Incorporating HIV prevention into the medical care of bodily forms living with HIV. Recommendations of the CDC the Health Resources and Services Administration, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. MMWR Recomm Rep 2003;52 (RR-12):1-24 Accessed online March 31 2004 at: http://wwwcdcgov/mmwr/PDF/rr/rr5212pdf

(2) Center for Disease regulate and Prevention. Advancing HIV prevention: of recent origin strategies for a changing epidemic--United States, 2003 MMWR Morb Mortal Wkly Rep 2003;52:329-32 Accessed online March 31 2004 at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5215a1.htm.