Prenatal and Neonatal HIV Testing

To the Editor. —Drs Minkoff and Willoughby¹ made several excellent points in their Commentary, but then they seemed to contradict themselves within the same article. The article is a clear affirmation that the use of zidovudine in pregnancy provides an unquestioned benefit with "no significant morbidity." The prenatal use of zidovudine is severely impaired by current human immunodeficiency virus (HIV) testing policies. Consequently, more than half of HIV-infected children remain unidentified to their parents or physicians at the time of hospital discharge.

The authors state that they cannot find a "rational justification" for unblinding the heelstick survey. I believe they contradict themselves by immediately providing at least two excellent reasons for doing so.

First, Pneumocystis carinii pneumonia (PCP) prophylaxis could be initiated earlier in the newborn. Pneumocystis carinii pneumonia is the most common opportunistic infection in pediatric patients with acquired immunodeficiency syndrome (AIDS). Simonds et al² recently reported