Multiple-marker screening in human immunodeficiency virus–positive pregnant women: screen positivity rates with the triple and quad screens

Special Considerations in the Management of HIV Infection in Pregnancy

“…However, the mechanism for these alterations of the tested biochemical markers is unclear. It has been postulated to be due to the altered maternal immune status or the impact of highly active antiretroviral therapy on feto-maternal transfer of these markers, their metabolism or their excretion by the mother (Yudin et al, 2003). In contrast to the above findings, Brossard et al (Brossard et al, 2008) concluded that these tests were still useful in a HIV-infected population composed of 214 women for first trimester screening tests and 209 women for risk assessment for neural tube defects.…”

“…Therefore it is important to review the current data on the usefulness of biochemical marker screening test in pregnant HIV-infected women. Variations in beta-hCG and AFP levels have been shown in HIV-infected pregnancies (Yudin et al, 2003;Einstein et al, 2004). This may make calculating the risk for Down syndrome difficult and might result in further diagnostic procedures.…”

“…In pregnancies complicated by HIV infection, there is a suspicion of a higher rate of falsepositive results when these women are screened with the maternal serum multiple marker test (Yudin et al, 2003). This may lead to a higher risk for HIV infected women to require definitive testing with genetic amniocentesis.…”

11.0 References

“…However, significantly increased levels of bHCG, a-fetoprotein and lower levels of UE3 (the elements of the 'triple test') have been observed in the HIV-positive population [209][210][211] while a reduction in bHCG in patients treated with PI-based [212] or with NNRTI-based HAART has been reported. As Down's syndrome is associated with increased bHCG, theoretically, HIV infection per se may increase the false-positive rate in women and thus increase the number of invasive tests offered compared with the uninfected population.…”

First and Second Trimester Markers of Fetal Aneuploidy in Pregnant Women with HIV Infection

“…Despite this and despite many developed countries having national policies for screening pregnant women for aneuploidy either in the second or first trimester of pregnancy, little is known as to whether HIV per se or anti-retroviral therapy has any impact on the level of markers used to screen for aneuploidy. In the second trimester, only three studies have looked at the impact of HIV infection on levels of ␣ -fetoprotein (AFP) and total hCG [1][2][3] , and one study has assessed the impact of antiretroviral drug regimes containing protease inhibitors [4] . More recently, Brossard et al [5] evaluated the reli- ability of second trimester screening for neural tube defect screening as well as evaluating the reliability of first trimester aneuploidy screening using combined biochemical and ultrasound screening.…”