Document Type

Conference Proceeding

Publication Date


Publication Title

Am J Obstet Gynecol


Objective: To compare the rates of false-positive HIV 4th generation screens among pregnant patients before and during the COVID-19 pandemic.

Study Design: A retrospective study evaluating the rates of false-positive HIV 4th generation screens among 44,187 pregnant patients was conducted. Pregnant patients from 3/2017-3/2019 were assigned to the “pre-COVID” cohort, and pregnant patients from 3/2020-3/2022 were assigned to the “COVID” cohort. Data including the date(s) and results of HIV 4th generation Ag/Ab combination tests and SARS-CoV-2 RT-PCR assays were ascertained via chart review. An HIV 4th generation test result was deemed “false-positive” if subsequent HIV-1/HIV-2 antibody differentiation immunoassays and/or HIV-1 nucleic acid tests were non-reactive.

Results: 42/22,073 (0.19%) patients with pre-COVID pregnancies who had HIV 4th generation tests were found to have abnormal results. In comparison, 71/22,114 (0.32%) patients with pregnancies during the pandemic had abnormal test results. 16/42 (38.1%) patients with abnormal results pre-COVID had false-positive HIV screens. In comparison, 48/71 (67.6%) COVID cohort patients with abnormal results had false-positive HIV screens. Overall, the rate of false-positive HIV 4th generation tests was significantly higher in the COVID cohort compared to the pre-COVID cohort (p=0.002). Among the 48 patients with false-positive HIV screens in the COVID cohort, 13 (27.1%) had a PCR-proven COVID-19 diagnosis during pregnancy preceding their false positive result. Interestingly, 9/13 patients (69.2%) also had at least one negative HIV 4th generation screening result predating their COVID-19 diagnosis.

Conclusion: Considering the maternal and neonatal implications of a positive HIV test result, OB/GYNs should be cognizant that false-positive results can occur in the setting of new/prior COVID-19 infections. Shared decision making should be used when considering the initiation of combination antiretroviral therapy, route of delivery and/or delay of breastfeeding for patients with a newly positive HIV 4th generation tests, particularly in the absence of other risk factors.





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