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Chapter: Obstetrics and Gynecology: The Obstetrician-Gynecologist’s Role in Screening and Preventive Care

Human Immunodeficiency Virus

The demographic of the HIV epidemic has changed over the last 2 decades.

HUMAN IMMUNODEFICIENCY VIRUS

 

The demographic of the HIV epidemic has changed over the last 2 decades. Prevalence has increased among ado-lescents, women, persons who reside outside metropolitan areas, and heterosexual men and women. Many are not aware that they are infected.

 

HIV testing is recommended for all women, and targeted testing is recommended for women with risk factors. Althoughwomen of reproductive age should be tested at least once in their lifetime, there is no consensus regarding repeat testing. 


Obstetrician–gynecologists should review their patient’s risk factors annually and assess the need for retesting. Repeat HIV testing should be offered at least annually to women who:

 

·            Are injection-drug users

·            Have sex partners who are injection-drug users or are HIV-infected

·            Exchange sex for drugs or money

·            Have been diagnosed with another sexually transmitted disease in the last year

·            Have had more than one sex partner since their most recent HIV test

 

Obstetrician–gynecologists should also encourage women and their prospective sex partners to be tested prior to ini-tiating a new sexual relationship. Periodic retesting could be considered even in the absence of risk factors, depend-ing on clinical judgment and the patient’s wishes.

 

The most common screening test is the enzyme-linked immunosorbent assay (ELISA), which is per-formed on a blood sample. There are also ELISA tests that use saliva or urine. A positive (reactive) ELISA must be confirmed by a supplemental test, such as the Western blot, to make a positive diagnosis.

 

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