{"id":40796,"date":"2021-07-01T06:43:36","date_gmt":"2021-07-01T06:43:36","guid":{"rendered":"https:\/\/i-base.info\/htb\/?p=40796"},"modified":"2021-07-01T07:13:56","modified_gmt":"2021-07-01T07:13:56","slug":"few-vertical-hiv-transmissions-in-the-uk-but-contributing-factors-remain-associated-with-inequality","status":"publish","type":"post","link":"https:\/\/i-base.info\/htb\/40796","title":{"rendered":"Few vertical HIV transmissions in the UK but contributing factors remain associated with inequality"},"content":{"rendered":"<div><\/div>\n<div>\n<p class=\"HTBsubhead3authorcredit\"><strong><span lang=\"EN-US\">Polly Clayden, HIV i-Base<\/span><\/strong><\/p>\n<\/div>\n<div>\n<p class=\"HTBBODYtext\"><strong><span lang=\"EN-US\">Vertical HIV transmission is rare in the UK, occurring mainly among undiagnosed women and often reflecting poor social circumstances \u2013 according to surveillance data presented at the 5th Joint Conference of the British HIV Association (BHIVA) with the British Association for Sexual Health and HIV (BASHH).<\/span><\/strong><\/p>\n<\/div>\n<div>\n<p class=\"HTBBODYtext\"><span lang=\"EN-US\">The UK vertical transmission rate has been below 0.3% since 2012. Despite very high uptake of antenatal screening, a small number of vertical transmissions still occur.<\/span><\/p>\n<\/div>\n<div>\n<p class=\"HTBBODYtext\"><span lang=\"EN-US\">These transmissions are monitored by the Integrated Screening Outcomes Surveillance Service (ISOSS), part of Public Health England\u2019s Infectious Diseases in Pregnancy Screening programme. ISOSS performs the following: <\/span><\/p>\n<\/div>\n<div>\n<ul>\n<li class=\"HTBBODYindent\"><span lang=\"EN-US\">Conducts active surveillance of all pregnancies to women living with HIV, their infants and any children diagnosed with HIV at less than 16 years of age.<\/span><\/li>\n<li class=\"HTBBODYindent\">Conducts enhanced data collection of vertical transmissions in children born since 2006.<\/li>\n<li class=\"HTBBODYindent\">Collects supplementary maternal and infant information through interviews with paediatric, maternity and HIV clinicians involved in each case.<\/li>\n<li class=\"HTBBODYindent\">Establishes circumstances surrounding transmissions and any contributing factors through a Clinical Expert Review Panel (CERP).<\/li>\n<\/ul>\n<\/div>\n<div>\n<p class=\"HTBBODYtext\"><span lang=\"EN-US\">A poster presentation at the conference described the latest findings on vertical transmissions from a review of cases reported between January 2014 and December 2019.<\/span><\/p>\n<\/div>\n<div>\n<p class=\"HTBBODYtext\"><span lang=\"EN-US\">There were 35 vertical transmissions in infants born to 33 mothers (including 1 set of siblings and 1 pair of twins). Years of birth ranged from 2006 to 2019 and infant age at diagnosis from birth to 11 years.<\/span><\/p>\n<\/div>\n<div>\n<p class=\"HTBBODYtext\"><span lang=\"EN-US\">The CERP identified the main factors contributing to transmission \u2013 in some cases there were overlapping and multiple factors.<\/span><\/p>\n<\/div>\n<div>\n<p class=\"HTBBODYtext\"><span lang=\"EN-US\">Two thirds of children were born to women diagnosed after pregnancy: 24 (69%) after, 4 (11%) during and 7 (20%) before pregnancy. <\/span><\/p>\n<\/div>\n<div>\n<p class=\"HTBBODYtext\"><span lang=\"EN-US\">Almost half were born in London: 15 (43%), 7 (20%) Midlands and east England, 6 (17%) north England, 3 (9%) south England and 4 (11%) Wales and Scotland. <\/span><\/p>\n<\/div>\n<div>\n<p class=\"HTBBODYtext\"><span lang=\"EN-US\">The median maternal age at delivery was 33 years (IQR 28 to \u00a036). Three quarters of mothers were born in sub-Saharan Africa: 26 (74%), 3 (9%) Eastern Europe and 6 (17%) UK.<\/span><\/p>\n<\/div>\n<div>\n<p class=\"HTBBODYtext\"><span lang=\"EN-US\">Over half the mothers (54%) reported adverse social circumstances: 5 safe guarding, 9 mental health, 7 housing, 3 drug\/alcohol use, 5 intimate partner violence, 5 uncertain immigration status, 4 financial issues and 7 English language issues.<\/span><\/p>\n<\/div>\n<div>\n<p class=\"HTBBODYtext\"><span lang=\"EN-US\">Of the 24 women diagnosed after pregnancy, 16 tested negative in pregnancy and seroconverted during pregnancy or breastfeeding. Some reported new or multiple partners during pregnancy. And some women had partners who did not disclose their HIV status and partners who died of HIV related symptoms.\u00a0\u00a0 \u00a0<\/span><\/p>\n<\/div>\n<div>\n<p class=\"HTBBODYtext\"><span lang=\"EN-US\">There were 5 transmissions among women who declined HIV testing, all occurring before 2010 \u2013 the authors noted that these women accepted all other infectious disease tests. One woman declined testing in two pregnancies and both children were diagnosed with HIV.<\/span><\/p>\n<\/div>\n<div>\n<p class=\"HTBBODYtext\"><span lang=\"EN-US\">Among the 11 women who were diagnosed before or during pregnancy, in 5 cases transmission was post-natal and likely due to non-disclosure of breastfeeding. These women had complicating factors including mental health issues and involvement by social services. Some women also had difficulties with engagement with health care services.<\/span><\/p>\n<\/div>\n<div>\n<h3 class=\"HTBcommenttitle\"><span lang=\"EN-US\">comment<\/span><\/h3>\n<\/div>\n<div>\n<p class=\"HTBBODYtext\"><strong><span lang=\"EN-US\">This ongoing enhanced data collection provides valuable insights into the circumstances behind the few vertical transmissions still occurring in the UK. ISOSS can also provide data on evolving patterns in this group, including maternal demographics, to inform work to address their needs.<\/span><\/strong><\/p>\n<\/div>\n<div>\n<p class=\"HTBBODYtext\"><strong><span lang=\"EN-US\">Presenting author, Helen Peters explained that although exact dates for vertical transmissions were not included the majority occurred in the earlier period of this surveillance and there has been a decline over the years.<\/span><\/strong><\/p>\n<\/div>\n<div>\n<p class=\"HTBBODYtext\"><strong><span lang=\"EN-US\">But the issues identified here support findings from previous reviews highlighting that social circumstances associated with inequality still drive the small numbers of vertical HIV transmissions that remain in the UK. \u00a0 \u00a0 \u00a0\u00a0<\/span><\/strong><\/p>\n<\/div>\n<div>\n<p class=\"HTBreferences\"><span lang=\"EN-US\">Reference<\/span><\/p>\n<\/div>\n<div>\n<p class=\"HTBreferences\"><span lang=\"EN-US\">Peters HP et al. Vertical transmissions in the UK- insights and remaining challenges. 5th Joint Conference of the British HIV Association (BHIVA) with the British Association for Sexual Health and HIV (BASHH). 19\u201321 April 2021.<b> <\/b>Poster abstract P027.<br \/>\n<\/span><a href=\"https:\/\/www.bhiva.org\/file\/6091178219915\/AbstractBook2021.pdf\">https:\/\/www.bhiva.org\/file\/6091178219915\/AbstractBook2021.pdf<\/a> (abstract book)<br \/>\n<a href=\"https:\/\/www.bhiva.org\/AnnualConference2021Presentations\">https:\/\/www.bhiva.org\/AnnualConference2021Presentations<\/a> (webcast \u2013 Themed poster discussion: ongoing challenges)<\/p>\n<p><em>This report was first published on 15 June 2021.<\/em><\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Polly Clayden, HIV i-Base Vertical HIV transmission is rare in the UK, occurring mainly among undiagnosed women and often reflecting poor social circumstances \u2013 according to surveillance data presented at the 5th Joint Conference of the British HIV Association (BHIVA) &hellip;<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4,35],"tags":[],"class_list":["post-40796","post","type-post","status-publish","format-standard","hentry","category-conference-reports","category-pmtct-and-maternal-health"],"_links":{"self":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/40796","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/comments?post=40796"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/40796\/revisions"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=40796"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=40796"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=40796"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}