TY - JOUR
T1 - Screening HIV-positive pregnant women for antiretroviral therapy
T2 - Utility of self-reported symptoms
AU - Nguyen, Ruby H.N.
AU - Gange, Stephen J.
AU - Serwadda, David
AU - Kigozi, Godfrey
AU - Kiwanuka, Noah
AU - Sewankambo, Nelson K.
AU - Wabwire-Mangen, Fred
AU - Quinn, Thomas C.
AU - Wawer, Maria
AU - Gray, Ronald H.
PY - 2006/2
Y1 - 2006/2
N2 - 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 CD4+ 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 CD4+ cell count criteria, and <1% met WHO staging criteria for AIDS. Using one or more symptoms to predict CD4+ cell count <350 cells/mm3, 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 ≥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.
AB - 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 CD4+ 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 CD4+ cell count criteria, and <1% met WHO staging criteria for AIDS. Using one or more symptoms to predict CD4+ cell count <350 cells/mm3, 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 ≥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.
KW - ART
KW - HIV
KW - Pregnant
KW - Symptomatology
KW - Viral load
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U2 - 10.1258/095646206775455801
DO - 10.1258/095646206775455801
M3 - Article
C2 - 16464273
AN - SCOPUS:33644529994
SN - 0956-4624
VL - 17
SP - 112
EP - 115
JO - International Journal of STD and AIDS
JF - International Journal of STD and AIDS
IS - 2
ER -