PEDIATRIC HIV DISEASE, ZIDOVUDINE IN PREGNANCY, AND UNBLINDING HEELSTICK SURVEYS - REFRAMING THE DEBATE ON PRENATAL HIV TESTING (REPRINTED FROM JAMA, VOL 274, PG 1165-1168, 1995)

Federal and state legislatures have recently taken up the issue of ide ntification of newborns exposed to the human immunodeficiency virus (H IV). Proposed legislation leg, the Coburn/Waxman HN testing amendment to the Ryan White CARE Act, the Ackerman Newborn HIV Notification Act [HR 1289], and NY A4413 and NY 52704) would include consideration of ' 'unblinding'' newborn heelstick surveys, which, until quite recently, were performed anonymously for surveillance purposes. These surveys, w hich relied on the detection of passively acquired maternal antibody t o HIV, allowed health departments to track the course of the HIV epide mic among women of reproductive age. By unblinding these surveys, ie, ending the anonymity built into current protocols, health departments would identify exposed newborns who could then be provided with approp riate therapeutic and prophylactic intervention. Since identification of exposed newborns relies on serological testing for passively acquir ed maternal antibody, such unblinding identifies infected women, and t his discussion becomes, in essence, only the most recent iteration of a decade-long debate on the appropriate standards for HIV testing of w omen. Although some of the ethical principles that underpin this debat e are inured to change leg, maternal autonomy and fetal beneficence), the backdrop against which these discussions are held has recently und ergone dramatic clinical changes.