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October 11, 1995

Pediatric HIV Disease, Zidovudine in Pregnancy, and Unblinding Heelstick SurveysReframing the Debate on Prenatal HIV Testing

Author Affiliations

From the Department of Obstetrics and Gynecology, State University of New York Health Science Center at Brooklyn (Dr Minkoff), and the Pediatric, Adolescent, and Maternal AIDS Branch, Center for Research for Mothers and Children, National Institute of Child Health and Human Development, National Institutes of Health, Rockville, Md (Dr Willoughby).

JAMA. 1995;274(14):1165-1168. doi:10.1001/jama.1995.03530140077036

FEDERAL AND state legislatures have recently taken up the issue of identification of newborns exposed to the human immunodeficiency virus (HIV). Proposed legislation (eg, the Coburn/Waxman HIV 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, which relied on the detection of passively acquired maternal antibody to HIV, allowed health departments to track the course of the HIV epidemic 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 appropriate therapeutic and prophylactic interventions. Since identification of exposed newborns relies on serological testing for passively acquired maternal antibody, such unblinding identifies infected women, and this discussion becomes, in

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