Use of surveillance data to investigate false positive HIV Western Blots in pregnant women

Guidelines from the CDC recommend that all pregnant women be offered voluntary human immunodeficiency virus (HIV) counseling, testing and referral. As a result, more pregnant women are being screened for the presence of antibodies to HIV. Many states have passed a law to permit the opt-out approach to prenatal HIV testing. However, it is documented there are over 60 factors that may affect the accuracy of an HIV antibody test, one of which is pregnancy. False positive and indeterminate test results present a challenge to the HIV/AIDS surveillance personnel who must confirm that a pregnant woman whose first positive HIV test result occurs during pregnancy is truly infected.

In this presentation, we will first present the phenomenon of false positive HIV in pregnant women through case studies, and then describe the additional guidelines that HDHHS has implemented to further investigate and verify the reportability of these individuals. To avoid misinforming patients about their HIV status, providers need to be aware of the possibility of false positive tests and know how to verify an indeterminate test. To avoid over reporting the incidence of HIV infection in pregnant women who may not be truly positive, the HIV surveillance programs must implement safeguards to thoroughly investigate and verify HIV diagnosis. Until more sensitive HIV testing algorithm is developed, the health care providers and surveillance units should consider adopting the additional guidelines to safely identify the true HIV positive status of the pregnant women.