ACOG committee opinion number 304, November 2004. Prenatal and perinatal human immunodeficiency virus testing: expanded recommendations.

Early identification and treatment of all pregnant women with human immunodeficiency virus (HIV) is the best way to prevent neonatal disease. Pregnant women universally should be tested for HIV infection with patient notification as part of the routine battery of prenatal blood tests unless they decline the test (ie, opt-out approach). Repeat testing in the third trimester and rapid HIV testing at labor and delivery are additional strategies to further reduce the rate of perinatal HIV transmission. The Committee on Obstetric Practice makes the following recommendations: follow an opt-out prenatal HIV testing approach where legally possible; repeat offer of HIV testing in the third trimester to women in areas with high HIV prevalence, women known to be at high risk for HIV infection, and women who declined testing earlier in pregnancy, as allowed by state laws and regulations; use conventional HIV testing for women who are candidates for third-trimester testing; use rapid HIV testing in labor for women with undocumented HIV status; and if a rapid HIV test result is positive, initiate antiretroviral prophylaxis (with consent) without waiting for the results of the confirmatory test.