Newborn screening for human immunodeficiency virus infection in the Bronx,NY, and evolving public health policy

New advances in the diagnosis and treatment of HIV infection continue to pr opel changes in public understanding of HIV infection and the administratio n of public health law. Over the past decade, New York State has moved from a policy of blind newborn screening for seroprevalence data to mandatory H IV testing as part of the statewide Newborn Screening (NBS) Program. A new statewide program of expedited HIV testing (48-hr turnaround results) of pr egnant women and newborns (whose HIV status is unknown at the time of deliv ery) began in the summer of 1999. To better understand the impact this prog ram might have on the patients who receive health care at Lincoln Medical a nd Mental Health Center (Lincoln Hospital), we evaluated our experience wit h the current NBS program prior to inauguration of the new expedited testin g program. We evaluated the NBS program from February 1, 1997, to January 3 1, 1999, including total number of HIV-exposed/infected infants born, mothe r's HIV status (if known) at the time of delivery, amount of time between b lood sampling and return of the test results to the Hospital, and medical f ollow-up of infants with positive newborn screening test results. This was a retrospective study of the NBS registry and the medical records of patien ts who receive primary health care from the Pediatric Immunology Service of the Department of Pediatrics at Lincoln Hospital. One hundred and four new borns were identified with positive-HIV antibody (HIV-Ab-positive), and 13 (12.5%) were confirmed to be HIV-infected by positive polymerase chain reac tion (PCR) test of viral DNA. Sixty-five (62.5%) of the newborns with posit ive NBS screening test results were born to mothers who were known to be HI V-infected prior to delivery; 39 (37.5%) were unanticipated. Four (30%) of the 13 HIV-infected babies were born to mothers who were known to be HIV-in fected prior to delivery, and 9 (70%) were born to mothers whose HIV status was unknown at the time of delivery. Eighty percent (80%) of HIV-Ab-positi ve infants continued to receive follow-up care at Lincoln Hospital. Relocat ion to other health-care facilities occurred as a result of parental choice or due to foster care placement. No babies were "lost" from the NBS progra m. The average time between sampling and receipt of results for all blood t ests was 16 days (range 10 to 141). Nearly 40% of newborns who acquired HIV infection from their mothers were unanticipated because the mother's HIV s tatus was unknown at the time of delivery. These unanticipated HIV-infected infants represent missed opportunities for prevention of maternal-to-child transmission of HIV infection and early therapeutic intervention for HIV-i nfected infants. The new expedited HIV-testing program for New York State w ill facilitate early diagnosis, prevention and treatment of the HIV-exposed /infected infant for whom maternal HIV status is unknown at the time of del ivery.