According to the Centers for Disease Control and Prevention (CDC), between 280 and 370 babies infected with HIV are born each year in the United States, despite recommendations for HIV testing for all pregnant women.

Voluntary HIV testing at the start of the prenatal period is undoubtedly the best measure to prevent perinatal transmission of HIV and also enables the woman herself to receive adequate medical care.

Assess the feasibility of using the OraQuick Rapid HIV-1 Antibody Test (OraSure Technologies Inc.) in women during childbirth, assess its sensitivity and specificity and promote early initiation of chemoprophylaxis for the detection of HIV, a study Rapid mother-child intervention in childbirth (MIRIAD) was conducted.

Analysis of research data has shown that using the rapid HIV test for women during childbirth achieves accurate and timely results and that most women are positive about the test.

The study was conducted in 16 American hospitals for 2 years (from November 16, 2001 to November 15, 2003). During this period, 91,707 women received maternity and maternity benefits, of which 7,381 met the criteria for inclusion in the study (professional activity with a gestational age of at least 24 weeks or admission to the a clinic with a gestational age of 34 weeks or more) and for whom, according to medical documentation, there was no evidence of HIV infection. Of these, 4,849 women agreed to participate in the study.

A blood sample was taken for women for the rapid test and the enzyme-linked immunosorbent assay (ELISA), if necessary, the confirmation of the results was carried out by immunoblotting.

With the simultaneous use of the rapid test and ELISA, HIV was detected in 34 women, which was confirmed by immunoblotting (the prevalence was 7/1000).

The rapid HIV test results in 4 cases were false positive and no false negative results. Thus, the sensitivity and specificity of the rapid test were 100% and 99.9% respectively, the prognostic value of a positive result * was 90%.

When using ELISA, 11 results were false positive, when verifying the results by immunoblot in 5 cases, the immunoblot result was doubtful, in 6 - negative. However, the researchers noted that the 11 women had negative results using the rapid test. The predictive value of a positive ELISA result was 76%, specificity - 99.8%.

The time required to obtain the result using the rapid test was 66 minutes (the time from the time of blood collection to the result), while using ELISA for this it took an average of 28 hours. When using ELISA, there were significant delays in obtaining the result, depending on the day the material was taken for the study (working days or weekends).

Of the 34 women diagnosed with HIV, 27 were admitted to the clinic during childbirth. Of these, 18 received zidovudine (Retrovir, GlaxoSmithKIine) during childbirth, 8 patients also received nevirapine (Viramune, Boehringer Ingelheim). Two women dropped out of the study and no further follow-up was done. In other women, due to time constraints, it was not possible to obtain test results before the baby was born and to start chemoprophylaxis.

The time required to start chemoprophylaxis with zidovudine (AZT, Retrovir, GlaxoSmithKIine) was on average 33 minutes, chemoprophylaxis started on average 6 hours before birth.

All children likely to be exposed to HIV received zidovudine chemoprophylaxis (AZT, GlaxoSmithKIine) immediately after birth (3.8 hours on average), 17 neonates also received a dose of nevirapine (Viramune, Boehringer Ingelheim). In 17 cases, the delivery went through the natural birth canal, in 15 - by cesarean section.

The children were diagnosed with HIV by PCR within 48 hours, 2, 6 weeks and 3 months after birth. HIV infection was only detected in 3 children, 2 of whom were born naturally. Observation up to 6 months, the researchers were able to carry out on 27 children.

Researchers have suggested that perinatal HIV transmission may be the result of missed opportunities for prevention.

Thus, a rapid diagnosis of HIV during childbirth not only informs a woman of her condition, but also provides an early start of chemoprophylaxis, reduces the risk of transmission of the virus and also allows patients to be referred for treatment later. appropriate medical care.