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Mother-to-child HIV transmission rates continue to decrease in UK
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Researchers reported a continued decline of mother-to-child HIV transmission rates in the United Kingdom and Ireland. The report, published in Clinical Infectious Diseases, showed a decline from 0.46% in 2010-2011 to 0.27% in 2012-2014.
Helen Peters, MSc, from the University College London Great Ormond Street Institute of Child Health, and colleagues collected comprehensive population-based data on all HIV-positive women seen for care in the U.K. and Ireland through surveillance within the National Study of HIV in Pregnancy and Childhood. They also followed up with HIV-exposed infants to establish infection status.
Peters and colleagues identified 3,290 singleton live-birth deliveries to women diagnosed with HIV prior to delivery in 2012-2014. To date, the researchers confirmed the status of infection in 78% of infants (n = 2,580); however higher risk for mother-to-child transmission (MTCT) among those with unknown status is unlikely.
In 2012-2014, 85% of deliveries were among women diagnosed before pregnancy (n = 2781) compared with 72% in 2007-2011 (4,776 of 6,585; P < .001). Further, 60% of overall deliveries in 2012-2014 were among women who conceived while receiving combination ART (1,874 of 3,136) compared with 40% in 2007-2011 (2,516 of 6,309). Eighty-seven percent of women delivered with HIV RNA less than 50 copies/mL (1,749 of 2,012), the MTCT rate among those was 0.14% (95% CI, 0.02-0.52). The researchers also reported an increase in vaginal deliveries from 37% in 2007-2011 to 46% in 2012-2014 (P < .001).
Seven transmissions occurred among the 2,580 babies with confirmed infection, yielding a 0.27% MTCT rate (95% CI, 0.11-0.56). Maternal diagnosis among the seven transmissions occurred before pregnancy in four cases, with three on treatment. The researchers reported two transmissions in utero, four intrapartum transmissions, and one intrapartum/postnatal.
Although the management of labor for women with HIV has changed, Peters and colleagues emphasized that women need continued support with adherence to treatment postnatally, especially when women start ART during pregnancy. They concluded that earlier initiation of ART contributed to the declining transmission rates in recent years. The ever-decreasing rate of MTCT demonstrates the impact of sustained efforts to provide the best treatment and care to all women living with HIV and their children. – by Savannah Demko
Disclosure: Peters reports no relevant financial disclosures. Please see the full report for all other authors’ disclosures.
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