Memorandum by the National Study of HIV
in Pregnancy and Childhood (HA 29)
Surveillance of obstetric and paediatric HIV
in the UK is carried out through the National Study of HIV in
Pregnancy and Childhood (NSHPC) at the Institute of Child Health,
University College, London. The NSHPC provides the paediatric
data for the overall national surveillance of HIV: summary data
are forwarded to the Health Protection Agency Centre for Infections
and Health Protection Scotland four times a year for integration
with adult data.
1. Anonymised demographic, laboratory and
clinical information on pregnant women is available; this includes
country of origin, timing of maternal diagnosis, uptake of interventions
to reduce the risk of mother to child transmission of infection
(antiretroviral therapy and mode of delivery), outcome of pregnancy
and the subsequent infection status of the child.
2. In the UK it is estimated that about
25% of HIV positive women who remain undiagnosed at delivery will
transmit infection to their baby. Antiretroviral therapy in pregnancy,
caesarean section delivery, and avoiding breast feeding substantially
reduce the risk of transmission, and most diagnosed women take
up these interventions. As a result, less than 2% of infants born
to diagnosed women in the UK are themselves infected.
3. Since the introduction of the routine
offer and recommendation of HIV testing to all pregnant women
as an integral part of antenatal care (in England in 2000, and
subsequently elsewhere in the UK), a steadily increasing proportion
of HIV infected pregnant women have been diagnosed before delivery.
In 2003 nearly 900 HIV infected women gave birth in the UK, of
whom over 90% were diagnosed before delivery. Nevertheless, about
170 infected children are believed to have been born in the UK
between 2000 and 2003, 80% of them to women who were undiagnosed
at the time of their child's birth. About two-thirds of these
infected children have been diagnosed and reported to the NSHPC
so far, including 13 who have died.
4. A majority of HIV infected pregnant women
giving birth in the UK were themselves born overseas. Any developments
which discourage women from accessing antenatal care, or restrict
their access to interventions, could result in avoidable transmission
of HIV from mother to baby.