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HIV screening of newborns.

Iowa has participated in the national survey for the prevalence of HIV infection in childbearing women since July of 1989. As of February 1992, blinded testing for antibodies to HIV has been performed on blood spot specimens from 100,717 newborns. Of this number, 14 were confirmed as positive by Western blot. In the Iowa survey the prevalence of HIV infection in childbearing women was 0.14/1000 or 1/7000. This is similar to the prevalence that was observed for PKU in newborns during this time period. However, assuming only 30% of mothers transmit HIV to their babies, the predicted prevalence of HIV infection in Iowa newborns is 1/23,000. Certainly HIV disease is a public health concern with a frequency in Iowa mothers similar to that of other diseases screened for in the Iowa program. HIV meets the remaining WHO criteria for newborn screening, as well: the HIV screening test is simple and reliable and has a low incidence of false-positive and false-negative results; confirmatory testing, counseling, and medical care are available; the quality and length of life of affected individuals are improved by treatment; and data show that early diagnosis and treatment result in a cost advantage to society. The major obstacle to the addition of HIV testing to a newborn screening program is obtaining informed consent without jeopardizing program effectiveness.