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

Ruby H.N. Nguyen, Stephen J. Gange, David Serwadda, Godfrey Kigozi, Noah Kiwanuka, Nelson K. Sewankambo, Fred Wabwire-Mangen, Thomas C. Quinn, Maria Wawer, Ronald H. Gray

Research output: Contribution to journalArticle

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 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.

Original languageEnglish (US)
Pages (from-to)112-115
Number of pages4
JournalInternational Journal of STD and AIDS
Volume17
Issue number2
DOIs
StatePublished - Feb 1 2006

Keywords

  • ART
  • HIV
  • Pregnant
  • Symptomatology
  • Viral load

ASJC Scopus subject areas

  • Dermatology
  • Public Health, Environmental and Occupational Health
  • Pharmacology (medical)
  • Infectious Diseases

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