Testing for the AIDS virus should become a routine part of pregnant women's prenatal care, a policy change that could help more mothers-to-be get treatment that can protect their babies from infection, a panel of medical experts told Congress.
The recommendation by the Institute of Medicine is sure to be controversial.The idea is for HIV testing to be just another one of the battery of tests, such as the test for syphilis, that pregnant women normally get, said the institute, which advises the federal government.
"The message to women is, this is a disease for which we can do a great deal right now," said Dr. Marie McCormick of Harvard University, who chaired the study. "If you find you're positive, there's a great deal we can do to keep you healthy and, more importantly, to prevent transmission to your child."
Under the recommendation, doctors would tell women they will automatically be tested for HIV as part of regular prenatal care unless they object. Women must be given a chance to refuse, the report stressed.
Taking the drug AZT during pregnancy significantly cuts an infected woman's chances of spreading the deadly virus to her baby. The AZT discovery caused births of HIV-infected babies to plummet 43 percent between 1992 and 1996.
Current federal guidelines urge doctors to counsel all pregnant women about HIV, including factors that increase risk of infection, and ask them to be tested. But many doctors don't counsel their patients, testifying before the institute that it is a burden.
In 1996, 1,600 babies were born with HIV. The government doesn't have more recent figures but says at least 432 babies were diagnosed with full-blown AIDS last year.
The vast majority of women are not infected - more than 4 million Americans get pregnant each year, an estimated 8,000 of them HIV infected. But making the test standard care would help diagnose more infected women while decreasing the stigma of AIDS testing, the report concluded.
Some state laws won't permit that, said Dr. Michael Greene of Massachusetts General Hospital, a spokesman for the American College of Obstetrics and Gynecology. Massachusetts law, for example, requires that women sign a form saying they received HIV counseling before they are tested, he said.
Also, HIV tests sometimes err, signaling infection in healthy people. "Without proper pretest counseling . . . there will be a lot of people unduly alarmed," Greene said, calling the institute's report "a substantial reversal" that the obstetricians' group must study.
The Centers for Disease Control and Prevention, which sets federal HIV testing guidelines, said that it will consider the recommendation but that women would need some basic HIV information before testing.
Counseling is not just for women who turn out to have HIV - it's how doctors explain to the healthy how to stay that way, stressed David Harvey of the AIDS Policy Center for Children, Youth & Families, which demanded that pretest counseling be required.
But the American Medical Association said notifying women of the tests is adequate.
The Institute of Medicine stressed that if thousands more women suddenly get HIV testing, they also must be better assured of follow-up medical care - AIDS treatment is expensive. It urged Congress to fund a $10 million program to fight HIV in newborns that has been pending since 1996.