New HIV diagnoses in children in UK and Ireland continue to decline

Numbers of newly diagnosed children in the UK and Ireland are still declining but an increasing proportion are born abroad and ART experienced, according to data presented at CROI 2017.

All HIV positive children diagnosed with HIV in the UK and Ireland (UK/I) are reported to the National Study of HIV in Pregnancy and Childhood (NSHPC). Those receiving paediatric HIV care are followed in the Collaborative HIV Paediatric Study (CHIPS). Datasets from the two studies were linked for this analysis.

The aim of the study was to describe evolving trends in the characteristics of children at diagnosis in the UK/I from 2000-2015 and in turn project the numbers entering or remaining in care up to 2020.

The analysis revealed 1,528 children were diagnosed from 2000-2015: 529 (35%) born in UK/I and 999 (65%) born abroad.

Overall age at diagnosis declined over time. Median age declined from 9 to 6 to 3 months for those born in the UK/I 2000-2005, 2006-2010 and 2010 or after respectively. The respective median ages for those born abroad were 6, 4.7 and 3 years.

There was a significant decline in the proportion of children with AIDS at diagnosis: 26% 2000-2003 to 2% in 2012-2015. The proportion with CDC B symptoms also fell from 34% to 11% in the respective time periods, p<0.001.

Of the children born abroad 23% were diagnosed before entering the UK/I. This proportion increased significantly over time: 8% in 2000-2003 to 55% in 2012 and after, p<0.001. By the time they arrived in UK/I 49% were ART experienced. Where ART regimen was known, 76% started on a NNRTI and 14% a boosted-PI based regimen. Of children linked in CHIPS with ART data after entry, 23% switched to a new regimen within one year of arrival.

As the CHIPS cohort grows older, an increasing number of participants are making the transition to adult HIV care. CHIPS investigators estimated that the cohort will halve in size by 2020 assuming that the numbers entering paediatric HIV care remain in decline or standstill. But the need for targeted adolescent services will increase.