ABSTRACT
New advances in the diagnosis and treatment of HIV infection continue to propel changes
in public understanding of HIV infection and the administration of public health law.
Over the past decade, New York State has moved from a policy of blind newborn screening
for seroprevalence data to mandatory HIV testing as part of the statewide Newborn
Screening (NBS) Program. A new statewide program of expedited HIV testing (48-hr turnaround
results) of pregnant women and newborns (whose HIV status is unknown at the time of
delivery) began in the summer of 1999. To better understand the impact this program
might have on the patients who receive health care at Lincoln Medical and Mental Health
Center (Lincoln Hospital), we evaluated our experience with the current NBS program
prior to inauguration of the new expedited testing program. We evaluated the NBS program
from February 1, 1997, to January 31, 1999, including total number of HIV-exposed/infected
infants born, mother's HIV status (if known) at the time of delivery, amount of time
between blood sampling and return of the test results to the Hospital, and medical
follow-up of infants with positive newborn screening test results. This was a retrospective
study of the NBS registry and the medical records of patients who receive primary
health care from the Pediatric Immunology Service of the Department of Pediatrics
at Lincoln Hospital. One hundred and four newborns were identified with positive-HIV
antibody (HIV-Ab-positive), and 13 (12.5%) were confirmed to be HIV-infected by positive
polymerase chain reaction (PCR) test of viral DNA. Sixty-five (62.5%) of the newborns
with positive NBS screening test results were born to mothers who were known to be
HIV-infected prior to delivery; 39 (37.5%) were unanticipated. Four (30%) of the 13
HIV-infected babies were born to mothers who were known to be HIV-infected prior to
delivery, and 9 (70%) were born to mothers whose HIV status was unknown at the time
of delivery. Eighty percent (80%) of HIV-Ab-positive infants continued to receive
follow-up care at Lincoln Hospital. Relocation to other health-care facilities occurred
as a result of parental choice or due to foster care placement. No babies were ``lost''
from the NBS program. The average time between sampling and receipt of results for
all blood tests was 16 days (range 10 to 141). Nearly 40% of newborns who acquired
HIV infection from their mothers were unanticipated because the mother's HIV status
was unknown at the time of delivery. These unanticipated HIV-infected infants represent
missed opportunities for prevention of maternal-to-child transmission of HIV infection
and early therapeutic intervention for HIV-infected infants. The new expedited HIV-testing
program for New York State will facilitate early diagnosis, prevention and treatment
of the HIV-exposed/infected infant for whom maternal HIV status is unknown at the
time of delivery.
KEYWORD
Congenital human immunodeficiency virus infection - newborn HIV testing - maternal-to-child-transmission
of HIV
