BMJ 1998;316:253-258 (24 January)

Papers

Epidemiology and detection of HIV-1 among pregnant women in the United Kingdom: results from national surveillance 1988-96

Angus Nicoll, consultant epidemiologist,a Christine McGarrigle, senior scientist,a Anthony R Brady, statistician,a A E Ades, reader in epidemiology and biostatistics,b Pat Tookey, research fellow,b Trinh Duong, statistician,b Janet Mortimer, senior scientist,a Susan Cliffe, senior scientist,a David Goldberg, deputy director,c David Tappin, senior lecturer,e Catherine Peckham, professor in epidemiology and biostatistics,b Chris Hudson, emeritus professor of obstetrics and gynaecology,d  for the principal collaborators

a AIDS and Sexually Transmitted Diseases Centre, PHLS Communicable Disease Surveillance Centre, London NW9 5EQ, b Department of Epidemiology and Biostatistics, Institute of Child Health, London WC1N 1EH, c Scottish Centre for Infection and Environmental Health, Ruchill Hospital, Glasgow G20 9NB, d Department of Obstetrics and Gynaecology, St Bartholomew's Hospital, London EC1A 7BF, e Department of Child Health, Royal Hospital for Sick Children, Glasgow G3 8SJ

Correspondence to: Dr Nicoll anicoll@phls.co.uk

Objective: To describe the epidemiology of HIV-1 infection in pregnant women in the United Kingdom.
Design: Serial unlinked serosurveillance for HIV-1 in neonatal specimens and surveillance through registers of diagnosed maternal and paediatric infections from reporting by obstetricians, paediatricians, and microbiologists.
Setting: United Kingdom, 1988-96.
Subjects: Pregnant women proceeding to live births and their children
Main outcome measures: Time trends in prevalence of HIV-1 seropositivity in newborn infants (as a proxy for infection in mothers); the proportions of mothers with diagnosed HIV-1 infections, and their characteristics.
Results: HIV-1 prevalence among mothers in London rose sixfold between 1988 and 1996 (0.19% of women tested; 1 in 520 in 1996). Apart from in Edinburgh and Dundee, levels remained low in Scotland (0.025%; 1 in 3970) and elsewhere in the United Kingdom (0.016%; 1 in 1930). Over a third of births to infected mothers in 1996 occurred outside London. In London the reported infections were predominantly among black African women, whereas in Scotland most were associated with drug injecting. The contribution of reported infection among African women increased over time as that of drug injecting declined. In Scotland 51% of mothers' infections were diagnosed before the birth. In England, despite a national policy initiative in 1992 to increase the antenatal detection rate of HIV, no improvement in detection was observed, and in 1996 only 15% of previously unrecognised HIV infections were diagnosed during pregnancy.
Conclusions: HIV-1 infection affects mothers throughout the United Kingdom but is most common in London. Levels of diagnosis in pregnant women have not improved. Surveillance data can monitor effectively the impact of initiatives to reduce preventable HIV-1 infections in children.

Key messages

  • HIV-1 infections among pregnant women are commonest in London but they are found in all parts of the United Kingdom

  • Black African ethnic group or a history of drug injecting are important risk factors, but HIV-1 infection occurs among women without either characteristic

  • Identification of HIV infection in pregnant women, if combined with uptake of interventions, reduces the risk of mother to child transmission

  • HIV testing should be universally available in all antenatal clinics without any obstacle

  • All pregnant women in London should be offered and recommended HIV testing; elsewhere, HIV testing should be offered and recommended to those with risk characteristics


Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to StumbleUpon StumbleUpon   Add to Technorati Technorati    What's this?

Relevant Article

Reducing the vertical transmission of HIV
Babatunde A Gbolade, K H Tan, K P Teo, Ben Essex, Mary A Waldron, Elizabeth Foley, V Harindra, Meg Goodman, Adeola Olaitan, Sara Madge, Melvyn Jones, Margaret Johnson, Fabio Parazzini, Elena Ricci, Paola Grasso, Matteo Surace, Guido Benzi, and Paquita de Zulueta
BMJ 1998 316: 1899. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

  • Bennett, R (2007). Routine antenatal HIV testing and informed consent: an unworkable marriage?. J. Med. Ethics 33: 446-448 [Full text]  
  • Townsend, C. L., Cliffe, S., Tookey, P. A. (2006). Uptake of antenatal HIV testing in the United Kingdom: 2000-2003. J Public Health (Oxf) 28: 248-252 [Abstract] [Full text]  
  • McGarrigle, C A, Cliffe, S, Copas, A J, Mercer, C H, DeAngelis, D, Fenton, K A, Evans, B G, Johnson, A M, Gill, O N (2006). Estimating adult HIV prevalence in the UK in 2003: the direct method of estimation. Sex. Transm. Infect. 82: iii78-iii86 [Abstract] [Full text]  
  • Ades, A. E., Cliffe, S. (2002). Markov Chain Monte Carlo Estimation of a Multiparameter Decision Model: Consistency of Evidence and the Accurate Assessment of Uncertainty. Med Decis Making 22: 359-371 [Abstract]  
  • Lim, W S, Macfarlane, J T, Colthorpe, C L (2001). Respiratory diseases in pregnancy {bullet} 2: Pneumonia and pregnancy. Thorax 56: 398-405 [Full text]  
  • Marcus, S. F., Avery, S. M., Abusheikha, N., Marcus, N. K., Brinsden, P. R. (2000). The case for routine HIV screening before IVF treatment: A survey of UK IVF centre policies. Hum Reprod 15: 1657-1661 [Abstract] [Full text]  
  • Gibb, D M, Neave, P E, Tookey, P A, Ramsay, M, Harris, H, Balogun, K, Goldberg, D, Mieli-Vergani, G, Kelly, D (2000). Active surveillance of hepatitis C infection in the UK and Ireland. Arch. Dis. Child. 82: 286-291 [Abstract] [Full text]  
  • Nicoll, A., Gill, O N., Peckham, C. S, Ades, A., Parry, J., Mortimer, P., Goldberg, D., Noone, A., Bennett, D., Catchpole, M. (2000). The public health applications of unlinked anonymous seroprevalence monitoring for HIV in the United Kingdom. Int J Epidemiol 29: 1-10 [Abstract] [Full text]  
  • de Zulueta, P. (2000). The ethics of anonymised HIV testing of pregnant women: a reappraisal. J. Med. Ethics 26: 16-21 [Abstract] [Full text]  
  • Duong, T., Ades, A E, Gibb, D. M, Tookey, P. A, Masters, J. (1999). Vertical transmission rates for HIV in the British Isles: estimates based on surveillance data. BMJ 319: 1227-1229 [Abstract] [Full text]  
  • (1999). HIV in pregnancy and early childhood. DTB 37: 65-67 [Abstract] [Full text]  
  • Boulton, M., Beck, E., Walters, S., Miller, D. (1999). General practice and the care of children with HIV infection: 6 month prospective interview study. BMJ 319: 232-235 [Abstract] [Full text]  
  • Postma, M J, Beck, E J, Mandalia, S, Sherr, L, Walters, M D S, Houweling, H, Jager, J C (1999). Universal HIV screening of pregnant women in England: cost effectiveness analysis. BMJ 318: 1656-1660 [Abstract] [Full text]  
  • Simpson, W. M, Johnstone, F. D, Goldberg, D. J, Gormley, S. M, Hart, G. J (1999). Antenatal HIV testing: assessment of a routine voluntary approach. BMJ 318: 1660-1661 [Full text]  
  • Gbolade, B. A, Tan, K H, Teo, K P, Essex, B., Waldron, M. A, Foley, E., Harindra, V, Goodman, M., Olaitan, A., Madge, S., Jones, M., Johnson, M., Parazzini, F., Ricci, E., Grasso, P., Surace, M., Benzi, G., de Zulueta, P. (1998). Reducing the vertical transmission of HIV. BMJ 316: 1899-1899 [Full text]  
  • Mercey, D. (1998). Antenatal HIV testing. BMJ 316: 241-242 [Full text]  
  • Gibb, D. M, MacDonagh, S. E, Gupta, R., Tookey, P. A, Peckham, C. S, Ades, A E (1998). Factors affecting uptake of antenatal HIV testing in London: results of a multicentre study. BMJ 316: 259-261 [Abstract] [Full text]  
  • Gill, N. (1998). Commentary: Promoting testing is no substitute for recognising risk. BMJ 316: 295-296 [Full text]  
Access jobs at BMJ Careers
Whats new online at Student BMJ