International Journal of STD & AIDS > Volume 17, Number 2 > Pp. 112-115

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Original research articles

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

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

Epidemiology Branch, National Institute of Environmental Health Sciences/NIH, Research Triangle Park, NC, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Makere University, Kampala, Uganda; Makere University, Kampala, Uganda; Makere University, Kampala, Uganda; Makere University, Kampala, Uganda; Makere University, Kampala, Uganda; Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA; Mailman School of Public Health, Columbia University, New York, NY, USA; Department of Population and Family Health Sciences, Bloomberg School of Public Health, Baltimore, MD, USA

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.

Key Words: HIV • SYMPTOMATOLOGY • PREGNANT • VIRAL LOAD • ART

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