Case 841 -- A 24 year-old female in labor at 38 weeks with a positive HIV screen

Contributed by Martina Pejchal, MD, PhD, and Bruce Rabin, MD, PhD


A 24 year-old Caucasian G3P1011 female was admitted at 38 weeks and 4 days with early labor. She had prenatal care from other hospital and her records were not available. Her past medical history was significant for a LEEP in 3/2013, G1 term IUFD with NSVD, and G2 SVD (6lb4oz) in 2009. She had no documentation of an HIV screen during this pregnancy; her current partner had not recently been tested and his status was unknown. She denied any high risk behaviors such as IV drug use, new partner, multiple partners, blood transfusion or exposure to infected blood. She also denied any viral like symptoms this pregnancy (but did have a dry cough for 1 month).

The rapid HIV Multispot test was performed and detests antibody to HIV-1 and HIV-2. The test was read as "preliminary positive" for antibody to HIV-1 according to the manufacturer's guidelines, which state that, "Note: The appearance of any purple color in any of the Test Spots, regardless of intensity, must be considered as presence of that Spot."

Shown above is the patient's actual rapid HIV Multispot test next to a positive and a negative control. The HIV-1 peptide spot was positive.

Shown above are the peptides used in the test which bind to the patient's antibodies.

What is the probability that this patient is HIV positive? Given that she is in active labor and we cannot confirm the preliminary positive result for a number of hours, should she be treated as HIV positive and given HIV antivirals and an immediate C section to protect the baby?


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