美国妇产科医师学会更新HIV产前检测推荐

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HIV产前检测的新指南指出早期发现和治疗有利于母亲、她的性伴侣及婴儿。美国妇产科医师学会在《Obstetrics & Gynecology》六月期刊上发布了新指南，以此代替2008年的委员会意见。

作者Denise Jamieson博士是美国疾病控制与预防中心的女性生殖健康部门首席，他说：比起之前，现在有更多的理由去确诊感染HIV的怀孕女性。此前，由于关注母婴传播的预防，母亲常常在孕期接受抗病毒治疗，但在分娩后结束用药。现在由于对HIV患者早期治疗的关注，大部分孕期确诊的女性将在孕后继续抗病毒治疗。
Jamieson博士在Medscape医学新闻栏目里说道：筛查对象的基本范围未改变。其包括：

1.女性应当在常规产前检测期间检测HIV。
2.注射毒品和怀孕期间有多个性伴侣的女性，应当在妊娠晚期再次检测。
3.未检测过的女性应当在分娩时接受快速筛查，如果快速筛查结果阳性，她们应当开始抗病毒治疗同时等待确诊结果。

抗病毒治疗可以预防HIV阳性女性将病毒传播给未感染的性伴侣，所以治疗有利于母亲、婴儿和性伴侣，而不是只有婴儿。

自从最新指南发布后，检测技术也发生改变。先前的检测依赖抗体筛查，但现在的筛查结合抗体和抗原的检测，同时也检测病毒的RNA。因此，检测可在几周内发现HIV感染，而不是几个月。

英文原文ACOG Updates Recommendations for Prenatal HIV Testing

New guidelines for HIV testing in pregnancy recognize that early detection and treatment can benefit the mother and her sexual partners, as well as the infant. The American College of Obstetricians and Gynecologists published the updated guidelines, which replace a 2008 committee opinion, in the June issue of Obstetrics & Gynecology.
"There are more reasons than ever to identify pregnant women who have HIV," said author Denise Jamieson, MD, chief of the Women's Health and Fertility Branch at the Centers for Disease Control and Prevention, Atlanta, Georgia. Previously, HIV prophylaxis was focused on preventing transmission to the baby, and women would often be treated with antiretrovirals during pregnancy, but taken off the drugs after birth. "Now, with the emphasis on earlier treatment [for all HIV patients], the vast majority of women who are identified during pregnancy will stay on antiretrovirals after their pregnancy."
That said, "the basics of who should be screened, and how often, have not changed," Dr Jamieson told Medscape Medical News.
Those basics are:
·         Women should be tested for HIV during routine prenatal testing, on an opt-out basis where possible.
·         Women at high risk for HIV, including injection drug users and women with multiple sex partners during their pregnancy, should be tested again in their third trimester.
·         Women who have not been tested should be offered rapid screening when in labor, and if the rapid test is positive, they should start antiretroviral therapy while waiting for results from a confirmatory test.
Antiretrovirals can prevent the chance of an HIV-positive woman passing the virus to an uninfected partner, so treatment is now understood to benefit the mother, baby, and the mother's partner, rather than just the baby.
Testing technology has also changed since the guidelines were last issued. Previous testing relied on antibody screening, but current screening uses combined antibody and antigen tests, as well as testing for viral RNA. As a result, tests can detect infections earlier, within weeks rather than months.