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

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

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


Data sources 1

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.


Data sources 2

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

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

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

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


Hiv infected children born in the uk since 2000 despite maternal diagnosis

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


Hiv infected children born in the uk since 2000 despite maternal diagnosis

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 audit 33 infants born to diagnosed women in england 2002 2005

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

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 women1

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 women2

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

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

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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