[Universal prenatal screening for HIV in Israel--is it justified?]

Mother-to-child transmission (MTCT) of HIV occurs during pregnancy but mainly during delivery and also at breastfeeding. Early prenatal testing and diagnosis of HIV positive asymptomatic women along with proper treatment of women and newborns reduces the MTCT rate from 20-45% to less than 1-2%. Thus, in the last decade, universal prenatal screening for HIV is recommended in many developed countries in order to diagnose and treat carriers and prevent child infection. According to the Ministry of Health guidelines regarding "Early diagnosis and treatment of HIV positive reproductive-aged women": HIV prevalence in the general population is low and therefore, prenatal HIV screening should be offered to high risk women ("when women or their sexual partner belong to one of the following risk groups: negotiated in unprotected occasional sex, drug addicts, sex service providers, immigrants from endemic areas and their children and those who had unprotected sex in endemic areas"). According to the guidelines, these women should be referred to an AIDS center for thorough explanations prior to testing (opt-in-approach). In the last decade approximately 10 children were diagnosed with HIV every year, only 2-6 of them were born in Israel. This article evaluates whether universal prenatal screening for HIV, similar to syphilis screening for example, is justified in Israel. HIV testing would be offered as part of the routine tests that each pregnant woman undergoes in early pregnancy and women can refuse testing (opt-out-approach). Careful appraisal of such a screening program shows that it is justified and might be an important step in preventing HIV transmission.