Late diagnosis often involved in mother-to-child transmission of HIV in the UK

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More can still be done to prevent mother-to-child transmission of HIV in the UK, according to an audit published on November 23rd.

There are approximately 30 cases of mother-to-child transmission in the UK each year and investigators from the Audit, Information and Analysis Unit, the Children’s HIV Association, the London HIV Consortium and the National Study of HIV in Pregnancy and Childhood conducted an audit of 87 such transmissions in England between 2002 and 2005.

Since 2000 an opt-out HIV test has been offered to all women receiving ante-natal care in the UK. It is possible to reduce the risk of mother-to-child transmission of HIV to less than 1% with antiretroviral therapy, appropriate intervention during labour, and by not breastfeeding.

Glossary

mother-to-child transmission (MTCT)

Transmission of HIV from a mother to her unborn child in the womb or during birth, or to infants via breast milk. Also known as vertical transmission.

antenatal

The period of time from conception up to birth.

standard of care

Treatment that experts agree is appropriate, accepted, and widely used for a given disease or condition. In a clinical trial, one group may receive the experimental intervention and another group may receive the standard of care.

window period

In HIV testing, the period of time after infection and before seroconversion during which markers of infection are still absent or too scarce to be detectable. All tests have a window period, the length of which depends on the marker of infection (HIV RNA, p24 antigen or HIV antibodies) and the specific test used. During the window period, a person can have a negative result on an HIV test despite having HIV.

Of the recent transmission examined in the audit, two-thirds involved infants born to mothers whose HIV remained undiagnosed during pregnancy, underlining the need for all women to have an HIV test at least once during pregnancy.

UK researchers recently reported HIV vertical transmissions involving women who had had a negative HIV test at the start of pregnancy but who subsequently had an HIV-infected baby, either because their first HIV test was in the ‘window period’ before antibodies had developed, or they were infected with HIV during pregnancy.

There were no cases of HIV transmission from a mother to her baby when women received the correct standard of care set out in UK HIV pregnancy guidelines.

Nevertheless, the authors of the audit believe that closer adherence to national guidelines could have prevented some of the infections that did occur.

“With the interventions currently available…very few infants should now be infected”, said Dr Hermione Lyall, chair of the Children’s HIV Association, “indeed, if any infant is found to be HIV-positive in the UK today, the details of the case should be examined to try and understand why.”

The audit did reveal areas where the management of HIV-infected women could be improved, and it includes the following recommendations:

  • Antenatal testing should be offered to all pregnant women, even those who present late or during labour.
  • Treating clinicians should be rapidly notified if a woman is HIV-positive.
  • Teams looking after pregnant women should have ‘fail safe’ lines of communication to make sure that pregnancy treatment plans can be promptly devised and implemented.
  • Women newly diagnosed with HIV should receive wide-ranging support during their pregnancy.
  • HIV care for pregnant women should be classified as emergency care ensuring that it is free to all women, regardless of their immigration, asylum or residence status.