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 per cent or higher to about one per cent.
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:
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
"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."
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