The rate of mother to child HIV transmission is at an all-time low in the UK, according to a paper published today in the journal AIDS.
The study examined over 12 000 pregnancies in women diagnosed with HIV before or during pregnancy and delivered in 2000-2011; there was a four-fold drop in the rate of mother to child transmissions, from 2.1% in 2000-2001 to 0.46% in 2010-2011.
Dr Claire Townsend (UCL Institute of Child Health) said: “Mother to child HIV transmission is now at the lowest level ever in the UK & Ireland, and as far as we’re aware such low levels have never been reported on such a large scale.”
The continued fall in transmission rates is thought to be due to a combination of factors including earlier initiation of antenatal combination antiretroviral therapy (cART) and an increase in the number of women already on cART when they conceive.
These new statistics are in line with the World Health Organisation’s goal of virtual elimination of mother to child transmission by 2015. The dramatic fall in the transmission rate in the UK can also be attributed to a very high uptake of antenatal HIV screening, which is offered to all pregnant women, and a multi-disciplinary approach to the management of HIV positive pregnant women and their babies.
How common is mother-to-child transmission today?
In 2011, around 330,000 children under the age of 15 became infected with HIV and an estimated 230,000 died from AIDS.4 Almost all of these infections were as a result of mother-to-child transmission and among children living in sub-Saharan Africa.
However, mother-to-child transmission can be averted, and in high-income countries mother-to-child transmission has been almost completely eliminated as a result of effective voluntary testing and counselling services, access to antiretroviral therapy, safe delivery practices, and the widespread availability and safe use of breast-milk substitutes. Globally, since 1995, more than 350,000 children have avoided HIV infection due to these interventions. If these interventions were available and accessible to women worldwide, they could prevent thousands of children from becoming infected with HIV each year.
The study found that there was a marked decline in the proportion of diagnosed HIV-positive pregnant women who received no antenatal cART from 3.3% in 2000-2006 to 1% in 2007-2011 and an increase in the duration of treatment during pregnancy. A longer duration of treatment was significantly associated with reduced transmission risk.
The study also highlighted the extensive inequalities in the availability of interventions to prevent mother to child HIV transmission worldwide. In the UK 99% of diagnosed HIV positive pregnant women receive cART, whilst UNAIDS estimates that similar treatment regimes in West and Central Africa reach only 27%. The statistics within Europe also show a large gap in access to treatment with transmission rates as much as 4-10 times higher in some parts of Eastern Europe (0.46% transmission in the UK, compared to 2-4% in Russia and 4-5% in the Ukraine), where prevalence of HIV in pregnant women is higher and access to antiretroviral drugs more limited.
Babies born to women with HIV should receive zidovudine (brand name: Retrovir) for 6 weeks after birth to prevent mother-to-child transmission of HIV. The HIV medicine protects the babies from infection with any HIV that passed from mother to child during childbirth.
HIV testing for babies born to women with HIV is recommended at 14 to 21 days after birth, at 1 to 2 months, and again at 4 to 6 months. Testing should be done using a test that looks directly for HIV in the blood (called a virologic HIV test).
Results on two virologic tests must be negative to be certain that a baby is not infected with HIV. The first negative result must be from a test done when a baby is 1 month or older and the second result from a test done when a baby is 4 months or older. Results on two HIV virologic tests must be positive to know for certain that a baby is infected with HIV.
If test results show that a baby has HIV, the baby will be switched from zidovudine to a combination of HIV medicines. HIV medicines help children infected with HIV live healthier lives.
Because HIV can spread in breast milk, HIV-infected women in the United States should not breastfeed their babies. In the United States, infant formula is a safe and healthy alternative to breast milk.
Dr Townsend added: “To maintain, and even improve on, these low transmission rates it’s vital that we continue to test early for HIV in pregnancy and provide appropriate support to all HIV-positive mothers.”
Notes to editors
2. Earlier initiation of ART and further decline in mother-to-child HIV transmission rates, 2000-2011 is published online in the journal AIDS on 25 February 2014.
3. Journalists can obtain copies of the paper by contacting the UCL Media Relations Office.
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