Screening HIV-positive pregnant women for antiretroviral therapy: utility of self-reported symptoms

Abstract

In developing countries, Mother-to-Child Transmission-Plus programmes propose to identify lifelong antiretroviral therapy (ART)-eligible women during antenatal care. Identification using AIDS-related symptoms is the most feasible screening procedure in resource-limited settings. It is not known if symptomatology in pregnant women is correlated with clinical criteria for ART initiation based on CD(4)+ cell count or HIV-1 viral load. In this population of HIV-positive pregnant women from Rakai District, Uganda, 8-23% were eligible for treatment by CD(4)+ cell count criteria, and <1% met WHO staging criteria for AIDS. Using one or more symptoms to predict CD(4)+ cell count <350 cells/mm(3), sensitivity was 100%, specificity 11%, positive predictive value (PPV) 25%, and negative predictive value (NPV) 100%. When using one or more symptoms to predict viral load > or =100,000 cps/mL, sensitivity was 100%, specificity 10%, PPV 6%, and NPV 100%. Initiation of treatment based on self-reported symptoms will over-treat because the majority of pregnant women with symptoms would not be eligible for treatment under current guidelines, but asymptomatic pregnant women are unlikely to require ART.

Predictors of CD4 Eligibility for Antiretroviral Therapy Initiation Among HIV-Infected Pregnant Women in Lusaka, Zambia

“…While one study examined predictors of mortality in HIV-infected pregnant women, 18 another built a predictor model for ART initiation in pregnant women based on self-reported symptoms. 19 Our analysis focuses on characteristics that are demographic and historical, and thus could be easy to implement in resource-limited settings where non-trained workers sometimes provide care. We acknowledge several limitations of this analysis.…”