Hiv infected children born in the uk since 2000 despite maternal diagnosis
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HIV-infected children born in the UK since 2000 despite maternal diagnosis. National Study of HIV in Pregnancy and Childhood. Claire Townsend UCL Institute of Child Health. NSHPC. HIV-infected children reported in the UK. Children born in the UK to diagnosed women

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HIV-infected children born in the UK since 2000 despite maternal diagnosis

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HIV-infected children born in the UK since 2000 despite maternal diagnosis

National Study of HIV in Pregnancy and Childhood

Claire Townsend

UCL Institute of Child Health

NSHPC


HIV-infected children reported in the UK

  • Children born in the UK to diagnosedwomen

  • Children born in the UK to women who were undiagnosed at the time of delivery

  • Children who were born abroad


Datasources (1)

  • National Study of HIV in Pregnancy and Childhood (NSHPC)

    • Surveillance scheme for paediatric and obstetric HIV in the UK and Ireland

  • Confidential, active reporting schemes

    • Pregnancies in diagnosed HIV-infected women (RCOG)

    • Infants born to HIV-infected women (BPSU)

  • Children followed up to establish infection status

    • Uninfected: negative PCR after 1 and 3 months of age or negative antibody test.


Datasources (2)

  • Audit of Perinatal Transmission of HIV in England 2002-2005

    • Collaboration between the NSHPC, the Audit Information and Analysis Unit for Specialised Services (AIAU), and CHIVA

  • Antenatal testing and maternal diagnosis

  • Pregnancy and HIV management

  • Social circumstances

  • Management of delivery

  • Postnatal details


Background – births to HIV infected women (UK and Ireland)

  • Over 7500 infants born 2000-2007

  • Rapid increase in diagnoses of HIV in pregnancy since routine screening promoted

  • 1200/year since 2005


Uptake of PMTCT interventions (2000-2006)

  • 97% on ART

    • 85% HAART

    • 13% ZDV mono

  • Of those on HAART

    • 24% before conception


Trends in uptake of ART and mother-to-child transmission (MTCT) rates, UK and Ireland


61 infected infants born to diagnosed women

Total infected infants to date

74

13

- mother received

no antenatal ART

8

- mother received <14 days of ART

36

- mother received ≥14 days of ART

3 deliveries <32wks

2 late diagnosis *

3 declined ART

2 deliveries <32wks

5 late diagnosis *

1 late presentation

Results

  • 4 lacked information on ART

  • 1 late diagnosis

  • 1 < 32 weeks

* Diagnosis <3 weeks before delivery


36

≥14 days of ART

16

elective CS

8

vaginal

12

emergency

CS

6 VL>10,000

(including 1 dual therapy)

10 el CS

3 vaginal

remaining

2 mono

+ VL>50

3

VL>10,000

1 <32 wks

3 32-34 wks

2 VL>10,000

Median duration of treatment: 8 weeks

Median gestation at initiation: 30 weeks

(IQR: 27-33 weeks)

- Concurrent maternal illness / infection

- In utero transmission


Perinatal Transmission Audit33 infants born to diagnosed women in England, 2002-2005

  • 3 women - labour ward staff were unaware of diagnosis until after delivery

  • 4 women diagnosed within 2 days of delivery

    • 3 recent arrivals/visitors, 2 delivered prematurely

  • 1 confirmed seroconversion in pregnancy

    • 1 other possible seroconversion


33 infants / diagnosed women

  • VL>10,000 within 2 weeks of delivery

    • 36% of women

  • In utero transmission

    • 22 infants with early PCR result reported (within 2 days of birth)

    • 50% had evidence of likely in utero transmission

  • Social issues

    • ~ 2/3 of the women had serious problems with immigration status and/or housing

    • or other major social or mental health problems


33 infants / diagnosed women

  • Delays

    • antenatal testing / reporting of results / initiating or changing treatment

  • Lack of communication between/within Trusts

    • laboratory / antenatal / HIV care / labour ward

  • Problems contacting women, women declining care or concealing status

  • Uncertainty about entitlement to free care


33 infants / diagnosed women

  • No transmissions were identified following

    • optimal care and

    • undetectable maternal viral load at delivery

  • Only one woman transmitted despite undetectable viral load at delivery

    • malaria while travelling abroad in early pregnancy

    • baby PCR positive on day 1 (in utero transmission)


Conclusion

  • Most transmissions from diagnosed women can be attributed to a combination of factors:

    • Insufficient maternal ART (often due to prem delivery or late presentation/diagnosis)

    • Unplanned delivery

    • High viral load

  • Audit revealed additional factors:

    • In utero transmission  increasing proportion

    • Communication issues

    • Immigration/housing issues


Acknowledgements

  • Royal College of Obstetricians & Gynaecologists

  • British Paediatric Surveillance Unit (Royal College of Paediatrics & Child Health)

  • Respondents to the NSHPC and everyone involved in reporting

    Funding

  • Health Protection Agency - NSHPC funding

  • Medical Research Council - CL Townsend, Training Fellowship

    Ethics

  • Multi-centre Research Ethics Committee (MREC/04/2/009)

    ICH team

    Principal Investigator: Pat Tookey

    Additional support: Catherine Peckham, Mario Cortina-Borja

    Co-ordinator: Janet Masters

    Researchers: Claire Townsend, Hiwot Haile-Selassie

    Administrative Assistants: Icina Shakes, Kate Francis

    Website: www.nshpc.ucl.ac.uk

    Email: [email protected]

NSHPC


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