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Background:  Rapid HIV testing late in pregnancy or at delivery provides a final opportunity to identify HIV-infected women in order to initiate ART prophylaxis to prevent mother-to-child HIV transmission (MTCT).

Methods:  MIRIAD is a CDC-funded study conducted since November 2001 at 18 hospitals in 6 U.S. cities. Eligible women included those with undocumented HIV status who:  were not in labor at ≥ 34 weeks gestation (LP); were in labor at ≥ 24 weeks gestation (PP); or  seroconverted during pregnancy (SC). Following written informed consent, the OraQuick Rapid HIV-1 Antibody Test and conventional EIA/WB were performed on maternal blood. Women and infants were managed according to the local standard of care. HIV-1 DNA PCR was used to determine infant infection status.

Results:  As of September 17, 2004, 47 women were found to be HIV-infected; 2 were lost prior to delivery, leaving 45 evaluable women. Nine received prenatal ART and 31 intrapartum  ART (17 zidovudine [ZDV], 13 ZDV/nevirapine [NVP], and 1 ZDV/lamivudine [3TC]/NFV). Of their 45 infants, 40 (89%) received preventive ART (18 ZDV, 22 ZDV/NVP) after birth; 35 infants (78%) had samples adequate to determine their infection status:  4 were infected (11%), 30 uninfected, and 1 remained with indeterminate HIV status. Of the 4 infected infants, 2 were DNA PCR positive on day 1, 1 on day 4, and 1 negative on days 1 and 18 but positive on day 47. Thus 3 of the 4 infected infants were presumed to have in utero infection. One of 3 infants born to a SC mother was infected (positive on day 1).

* evaluable infants

Conclusions:  Rapid HIV-1 testing of women with unknown HIV status allowed for the initiation of preventive ART in 69% of women and 89% of their infants. The observed overall (11%) and intrapartum (2.9%, 1/35) infection rates are similar to those of other studies of intrapartum ART and suggest that this strategy is effective in preventing intrapartum transmission.

Keywords: mother child transmission; rapid testing; infant