TORCH testing in HIV-infected women

The issue of TORCH testing in pregnant women infected with the HIV virus remains confusing, even more so than it is in the non-HIV-infected gravida. Unfortunately, the data presented in this article make the recommendations of how to test for these various infections in pregnancy that much more difficult. Patients who are newly diagnosed as being HIV-infected and referred for prenatal care or who have not had TORCH testing probably should be tested. Thus, the prenatal patient with newly diagnosed HIV infection should be tested for T. gondii IgG antibodies. If positive for IgG antibodies, IgM antibodies should be obtained in an attempt to rule out acute T. gondii infection. Patients who test negative do not require any further testing until after the pregnancy unless they are severely immunocompromised and show signs and symptoms of toxoplasmosis. Antibodies (IgG) to CMV should be obtained in the HIV-infected gravida who is at high risk for CMV disease, i.e., patients with CD4+ T cell counts less than 100/mm3. Unfortunately, the previously described problems with antibody detection make this testing less than ideal; thus, it is not routinely recommended in the HIV-infected pregnant patient who presents for prenatal care except for those at risk of disease reactivation. As for herpes simplex virus testing, there is no value in routinely testing patients prenatally for evidence of the disease. Finally, syphilis testing in the HIV-infected gravida is of major importance. Once tested, the patient who tests negative and who remains at risk for infection should probably be retested in the third trimester. Patients who are found to have the disease and who are treated need to be tested serially to rule out re-infection or treatment failure.