Mother-To-Child Transmission Of HIV, UK

Main Category: HIV / AIDS
Also Included In: Pediatrics / Children's Health;  Women's Health / Gynecology
Article Date: 23 Nov 2007 - 9:00 PST

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In the UK HIV testing has been recommended to all women attending for antenatal care since 2000, and high test uptake and appropriate management for diagnosed women has reduced the mother-to-child transmission rate from 25%1 or higher to about 1%. However, there is still room for improvement, according to a joint report published today by the Audit, Information and Analysis Unit, the National Study of HIV in Pregnancy and Childhood, the Children's HIV Association and the London HIV Consortium.

Across the UK more than 30 infants are still infected annually with HIV, and each carries a substantial human and economic cost. Despite the decline in the proportion of children being infected, the actual numbers each year have not changed significantly because of the overall increase in the number of HIV infected women giving birth.

This audit examined the circumstances surrounding 87 recent cases of mother-to-child transmission (among infants born in England between 2002 and 2005). Nearly two-thirds of these infants were born to women whose HIV infection remained undiagnosed during pregnancy, highlighting the importance of ensuring that all pregnant women are offered every opportunity to be tested antenatally.

Reassuringly, the audit found no cases in which transmission occurred following optimal care and good maternal health. However, despite the generally positive picture, a number of areas were identified where changes in policy and practice, and closer adherence to national guidelines, could make a difference in individual cases and further reduce the overall transmission rate.

Hermione Lyall, Chair of CHIVA said:

'As a paediatrician looking after HIV infected children, I know how hard it is for families living with this chronic disease. Even though HIV is now treatable it cannot yet be cured and an infant infected with the virus will need to be treated life long. With the interventions currently available to interrupt transmission of the virus from mother to child, very few infants should now be infected. Indeed if any infant is found to be HIV positive in the UK today, the details of the case should be examined to try to understand why.

This audit has demonstrated some of the areas where we can improve our management for the benefit of mothers and their babies. We need to ensure that:

- Antenatal HIV testing is offered and recommended to all women, even those who present late or in labour.
- Positive HIV test results are rapidly reported to clinicians.
- Teams looking after women with HIV have failsafe lines of communication so that pregnancy treatment plans can be devised and implemented in a timely fashion.
- Units follow the BHIVA guidelines for the management of HIV in pregnancy.
- Newly diagnosed women are holistically supported throughout the pregnancy.

HIV care for the pregnant mother is classified as emergency care and is free to all women, regardless of immigration, asylum or residence status.

Over the years one of the great parts of my job has been the opportunity to inform a mother that her baby's tests are negative and her baby does not have HIV. We hope that units will take the recommendations of the audit onboard, review their practice and all of us will work together to optimise the care of pregnant women with HIV.'

Notes:

Duong T, Ades AE, Gibb DM, Tookey PA, Masters J. Vertical transmission rates for HIV in the British Isles: estimates based on surveillance data. BMJ 1999; 319:1227-29

87 infants were diagnosed with perinatally acquired HIV born in England 2002-2005, and reported through the NSHPC confidential surveillance system by 31 March 2006. Subsequently, a further 24 children born during the study period were diagnosed and reported by March 2007, most of whom were born to undiagnosed women in 2004/5.

Information on the AIAU, NHSPC, CHIVA and the London HIV Consortium

The AIAU produces clinical information to support clinicians, trust managers, commissioners, patients and the public to understand the nature and quality of specialised services across providers. The remit includes Trusts providing specialised services in London, Kent, Surrey and Sussex, Essex, Bedfordshire and Hertfordshire. (http://www.nww.esussexaiau.nhs.uk/ (accessible from NHS Network only))

The National Study of HIV in Pregnancy and Childhood (UK and Ireland) is the confidential reporting scheme for pregnancies in HIV-infected women, babies born to HIV-infected women and children with HIV infection (http://www.nshpc.ucl.ac.uk)

The London HIV Consortium is a collaboration between London PCTs and NHS providers for the planning, procurement and performance management of HIV treatment and care services.

The Children's HIV Association (CHIVA) is an association of professionals who are committed to providing excellence in the care of children infected or affected by HIV and their families.

Children's HIV Association