Washington--Medical screening of newborn infants to determine if they have the antibodies to the virus that causes acquired immune deficiency syndrome is too questionable to warrant widespread use, the Institute of Medicine concludes in a new report.
However, the institute, a branch of the National Academy of Sciences here, recommends making the test available to pregnant women in areas where the human immunodeficiency virus that causes the disease is especially prevalent.
A committee of 10 experts on medical and public-policy issues prepared the document.
Testing of newborns for hiv is not justified, the report concludes, because the test reveals only the presence of maternal antibodies in the infant, the risks of the tests are unclear, and only about 33 percent of babies whose tests reveal the antibodies may in fact be infected.
“Detection of maternal hiv antibodies reveals only that the mother, and not necessarily the infant, is infected,” the institute states in a summary of the report.
Thus, it says, screening of newborns would be “tantamount to involuntary maternal screening” and would mean that women who have just given birth “would be the only ci8vilian, non-institutionalized adult population not given the opportunity to consent to or refuse hiv testing.”
That, the panel states, would be “ethically unacceptable.”
All women “should have the right to consent to or refuse” the test and written, informed consent should be obtained first, the report states.
A 1989 survey of newborn infants in New Jersey determined that 0.54 percent carried hiv-positive antibodies in their blood. The Newark district currently is dealing with one of the highest per-capita rates of pediatric aids in the nation. (See Eduel15lcation Week, Jan. 16, 1991.)
The committee also did not recommend testing for all pregnant women in the United States because the prevalence of hiv infections varies widely across the country. Women with aids and the hiv infection mostly are found in large metropolitan areas of the East Coast and in Puerto Rico.
Yet, the report adds, voluntary screening of pregnant women can be important, permitting early detection and treatment.
Medicines for the treatment of hiv infections, such as azt, “are not without toxicity,” and giving them to all babies testing positive would mean many infants “would be exposed to substantial toxicity with4out deriving any medical benefits,” the panel adds.
The committee advises that prenatal hiv-screening programs include resources for medical evaluation and treatment as well as educational components. Such components could include information on how the virus is transmitted, ways to reduce the risk of transmission, treatment options, and potential psychological and social ramifications of being identified as hiv-positive.
Copies of the report, “Hiv Screening of Pregnant Women and Newborns,” are available for $19 each, plus shipping, from the National Academy Press, 2101 Constitution Ave., N.W., Washington, D.C. 20418.
