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Pediatric HIV Disease, Zidovudine in Pregnancy, and Unblinding Heelstick Surveys: Title and subTitle BreakReframing the Debate on Prenatal HIV Testing FREE

Howard Minkoff, MD; Anne Willoughby, MD, MPH
[+] Author Affiliations

This article does not represent the opinion of the US Public Health Service.

Reprint requests to Department of Obstetrics and Gynecology, SUNY Brooklyn Health Science Center, 450 Clarkson Ave, Box 24, Brooklyn, NY 11203 (Dr Minkoff).


JAMA. 1995;274(14):1165-1168. doi:10.1001/jama.1995.03530140077036
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FEDERAL AND state legislatures have recently taken up the issue of identification of newborns exposed to the human immunodeficiency virus (HIV). Proposed legislation (eg, the Coburn/Waxman HIV testing amendment to the Ryan White CARE Act, the Ackerman Newborn HIV Notification Act [HR 1289], and NY A4413 and NY 52704) would include consideration of "unblinding" newborn heelstick surveys, which, until quite recently, were performed anonymously for surveillance purposes. These surveys, which relied on the detection of passively acquired maternal antibody to HIV, allowed health departments to track the course of the HIV epidemic among women of reproductive age. By unblinding these surveys, ie, ending the anonymity built into current protocols, health departments would identify exposed newborns, who could then be provided with appropriate therapeutic and prophylactic interventions. Since identification of exposed newborns relies on serological testing for passively acquired maternal antibody, such unblinding identifies infected women, and this discussion becomes, in

REFERENCES

Connor EM, Sperling RS, Gelber R, et al.  Reduction of maternal-infant transmission of human immunodeficiency virus with zidovudine treatment. N Engl J Med . 1994;;331:1173-1180.
Cotton P.  Trial halted after drug cuts maternal HIV transmission rate by two thirds. JAMA . 1994;;271:807.
Centers for Disease Control and Prevention.  Recommendations of the U.S. Public Health Service Task Force on the use of zidovudine to reduce perinatal transmission of human immunodeficiency virus. MMWR Morb Mortal Wkly Rep . 1994;;43:1-15.
Landesman S, Minkoff HL, Holman S, McCalla S, Sijin O.  Serosurvey of human immunodeficiency virus infection in parturients: implications for human immunodeficiency virus testing programs of pregnant women. JAMA . 1987;;258:2701-2703.
Krasinsky K, Borkowsky W, Bebenroth D, Moore T.  Failure of voluntary testing for human immunodeficiency virus to identify infected parturient women in a high-risk population. N Engl J Med . 1988;;318:185.
Minkoff HL, Landesman SH, Delke I, et al.  Routinely offered prenatal HIV testing. N Engl J Med . 1988;;319:1018.
Human Immunodeficiency Virus Infection . Washington, DC: American College of Obstetricians and Gynecologists; 1992;;162:1-11.
Sperling R, Stratton P, O'Sullivan MJ, et al.  A survey of zidovudine use in pregnant women with human immunodeficiency virus infection. N Engl J Med . 1992;;326: 857-861.
Centers for Disease Control and Prevention. National HIV Serosurveillance Summary: Results Through 1992 . Atlanta, Ga: US Dept of Health and Human Services, Public Health Service; 1994;:3.
Lindsay MK, Peterson HB, Feng TI, Slade BA, Willis S, Klein L.  Routine antepartum human immunodeficiency virus infection screening in an inner-city population. Obstet Gynecol . 1989;;74:289-294.
Bayer R.  Public health policy and the AIDS epidemic: an end to HIV exceptionalism? N Engl J Med . 1991;;324:1500-1504.
Bayer R.  Ethical challenges posed by zidovudine treatment to reduce vertical transmission of HIV. N Engl J Med . 1994;;318:1223-1225.
Wheat ME, Hyman RB, Devons C, Solomon S.  Preventing HIV transmission: behaviors and attitudes of medical house staff in a high-prevalence area. Am J Prev Med . 1993;;9:307-316.
Bayer R.  It's not Tuskegee revisited. Washington Post . (May 26) , 1995;:A27.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

Connor EM, Sperling RS, Gelber R, et al.  Reduction of maternal-infant transmission of human immunodeficiency virus with zidovudine treatment. N Engl J Med . 1994;;331:1173-1180.
Cotton P.  Trial halted after drug cuts maternal HIV transmission rate by two thirds. JAMA . 1994;;271:807.
Centers for Disease Control and Prevention.  Recommendations of the U.S. Public Health Service Task Force on the use of zidovudine to reduce perinatal transmission of human immunodeficiency virus. MMWR Morb Mortal Wkly Rep . 1994;;43:1-15.
Landesman S, Minkoff HL, Holman S, McCalla S, Sijin O.  Serosurvey of human immunodeficiency virus infection in parturients: implications for human immunodeficiency virus testing programs of pregnant women. JAMA . 1987;;258:2701-2703.
Krasinsky K, Borkowsky W, Bebenroth D, Moore T.  Failure of voluntary testing for human immunodeficiency virus to identify infected parturient women in a high-risk population. N Engl J Med . 1988;;318:185.
Minkoff HL, Landesman SH, Delke I, et al.  Routinely offered prenatal HIV testing. N Engl J Med . 1988;;319:1018.
Human Immunodeficiency Virus Infection . Washington, DC: American College of Obstetricians and Gynecologists; 1992;;162:1-11.
Sperling R, Stratton P, O'Sullivan MJ, et al.  A survey of zidovudine use in pregnant women with human immunodeficiency virus infection. N Engl J Med . 1992;;326: 857-861.
Centers for Disease Control and Prevention. National HIV Serosurveillance Summary: Results Through 1992 . Atlanta, Ga: US Dept of Health and Human Services, Public Health Service; 1994;:3.
Lindsay MK, Peterson HB, Feng TI, Slade BA, Willis S, Klein L.  Routine antepartum human immunodeficiency virus infection screening in an inner-city population. Obstet Gynecol . 1989;;74:289-294.
Bayer R.  Public health policy and the AIDS epidemic: an end to HIV exceptionalism? N Engl J Med . 1991;;324:1500-1504.
Bayer R.  Ethical challenges posed by zidovudine treatment to reduce vertical transmission of HIV. N Engl J Med . 1994;;318:1223-1225.
Wheat ME, Hyman RB, Devons C, Solomon S.  Preventing HIV transmission: behaviors and attitudes of medical house staff in a high-prevalence area. Am J Prev Med . 1993;;9:307-316.
Bayer R.  It's not Tuskegee revisited. Washington Post . (May 26) , 1995;:A27.
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