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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 June 23; 334(7607): 1287–1288.
PMCID: PMC1895667
HIV and pregnancy

Are we doing enough?

A Jayasuriya, specialist registrar and P S Allan, consultant

Gray and McIntyre report that the rates of mother to child transmission of HIV are dramatically reduced by antiretroviral use, caesarean section, and avoidance of breastfeeding.1 However, none of these effective interventions can take place without awareness of the mother's HIV status.

In the United Kingdom, all antenatal clinics routinely offer HIV testing.2 Most mothers accept screening. Two recent cases, however, highlight the deficiencies in the existing system. In 2006 the two infants were diagnosed with HIV within a few weeks of one another. Both mothers had had antenatal screening, and both tested HIV negative.

Current antenatal testing policies fail to take into account ongoing risk exposure. In addition, women who seroconvert during pregnancy are at a greater risk of transmitting HIV to their babies as the maternal viral load is at its highest at seroconversion. An alternative explanation is that both patients were tested during the serological window period. The information leaflet on HIV testing produced by the Department of Health3 and distributed in our antenatal clinic does not include an explanation about the HIV window period, and retesting is not routinely offered to those at higher risk.

Subsequent to these two cases, local antenatal services have altered their HIV testing policies to offer repeat testing of high risk individuals at 32 weeks of pregnancy. Midwives are being made aware of these issues and recommended to consider ongoing risks in all women. Contact tracing as is currently offered to HIV positive women should be offered to high risk HIV negative women as well. High risk women who initially refuse testing in pregnancy should be offered counselling by trained health advisers, with mechanisms in place to offer testing again later in their pregnancy. We see this as a thoughtful, inexpensive approach, serving as a safety net for those let down by the current antenatal system.


Competing interests: None declared.


1. Gray GE, McIntyre JA. HIV and pregnancy. BMJ 2007;334:950-3. (5 May.) [PMC free article] [PubMed]
2. Chief Medical Officer's Expert Advisory Group on AIDS. Reducing mother to baby transmission of HIV London: Department of Health, 1999.
3. Chief Medical Officer's Expert Advisory Group on AIDS. HIV testing as part of your antenatal care: better for your baby London: Department of Health, 2000

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