Obstetric and paediatric HIV surveillance data from the UK and Ireland

Population, Policy and Practice Programme

UCL Great Ormond Street Institute of Child Health

January 2019 update

National Surveillance of HIV in Pregnancy and Childhood (NSHPC)

• Comprehensive observational surveillance of obstetric and paediatric HIV in

the UK and Ireland, in place since 1990

• Maternity reports of all pregnancies in women with diagnosed HIV infection

through maternity units; demographics, pregnancy management, outcome

• Paediatric reports of all HIV-exposed infants through clinics and BPSU orange

card; NSHPC confirmation of infection status, with on-going follow-up of

infected children through CHIPS collaboration

• Complementary reporting schemes, no interventions, no enrolment; maternity

and paediatric reports linked

• Audit of newly reported infant transmissions

Pregnancies in women with diagnosed HIV, 1990 to date

475801

4273

75596976

4449

0

1000

2000

3000

4000

5000

6000

7000

8000

1990-94 1995-99 2000-04 2005-09 2010-14 2015-date

Pre

gn

an

cies

rep

ort

ed

Year of birth or EDD

Source: pregnancies since 1990 reported to the NSHPC from all sources by December 2018

24,533 pregnancies in diagnosed women since

1990

Pregnancy outcomes, 1990 to date

24,533 PREGNANCIES

20,891 LIVEBIRTHS

85.2%

199 STILLBIRTHS

0.8%

1,565 MISCARRIAGES

6.4%

819 TERMINATIONS

3.3%

1,059 OTHER 4.3%

Source: pregnancies since 1990 reported to the NSHPC from all sources by December 2018

Maternal demographics, early 2000s and now

2000-04

57.2%

30.9%

2.5%

0.9%

8.4%

2015-

35.4%

52.5%

3.3%

2.4%

6.4%

Country/region of report

London

Rest of England

Scotland

Wales / N. Ireland

Ireland

Median age (years)

IDU-acquired HIV

Perinatal HIV

African-born

Eastern Europe*-born

29

3.4%

0.03%

77.7%

0.3%

34

1.4%

2.6%

67.6%

6.1%

Source: pregnancies since 1990 reported through NSHPC maternity scheme by December 2018

* includes the Baltic

states (Estonia, Latvia,

Lithuania)

Timing of maternal HIV diagnosis, 1998-2018

0

200

400

600

800

1000

1200

1400

1600

1998 2000 2002 2004 2006 2008 2010 2012 2014 2016 2018

Year of birth or EDD

during this pregnancy

before this pregnancy

UK & Ireland pregnancies (all outcomes) reported to NSHPC by December 2018*

* includes data from all

NSHPC reporting

sources

** reporting delay for

recent years

Nu

mb

er

of

pre

gn

an

cies

**

89% of pregnancies

since 2015 have been in women diagnosed pre-

conception

Timing of diagnosis & ART at conception, 1998-2018

0

200

400

600

800

1000

1200

1400

1600

1998 2000 2002 2004 2006 2008 2010 2012 2014 2016 2018Prior diagnosis, ART at conception Prior diagnosis, no ART at conception

Other* Antenatal diganosis

* contains pregnancies

lacking information

on precise timing of

diagnosis and/or ART

use

** reporting delay for

recent years

**

UK & Ireland pregnancies (all outcomes) reported to NSHPC by December 2018

~80% of pregnancies

since 2015 have been conceived on antiretroviral

therapy

Nu

mb

er

of

pre

gn

an

cies

Shifts in mode of delivery among diagnosed women, UK 2000-2017

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Year of delivery (number of births)

Vaginal

Emergency caesarean

Elective caesarean

Pro

po

rtio

n o

f d

elive

ries

UK deliveries reported to NSHPC by December 2018*

**

* includes data from all

NSHPC reporting

sources

** reporting delay for

recent years

~2400 children*

living with HIV

(under 16s)

diagnosed since

1986 and reported

by December 2018

90% vertical

transmission

median age

21 years (IQR

17-25) at

end of Dec

2018

12% have

died

45% born in

UK or Ireland

442 (20%) children

were under 16 at

end of Dec 2018

(333 (75%) of these

have been seen for

care since 2017)

Children living with HIV, 1986 to date

Transition to adult care,

life-long ART and HIV

Annual data on infected

children and adolescents* excludes 267 children with haemophilia

reported through a separate scheme

Infection status of children born to diagnosed women

0

200

400

600

800

1000

1200

1400

pre-

90

90-99 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016* 2017*

Year of birth

infected

indeterminate

not infected

Nu

mb

er

of

child

ren

* incomplete

due to

reporting

delay

UK & Ireland births reported to NSHPC by December 2018

Vertical transmission in UK/Ireland, 2000-2016

Data for 2000-11 from: Townsend et al. AIDS 2014; data for 2012-14 from Peters et al. CID 2016; data

from 2015-16 from: Peters et al. HIV Drug Therapy Glasgow 2018

Perinatal HIV transmission audit: UK births 2006-2013

0

5

10

15

20

25

2006

(31)

2007

(25)

2008

(18)

2009

(12)

2010

(9)

2011

(6)

2012

(6)

2013

(1)

Year of delivery (total number of cases)

Mother dx after pregnancy (67 cases)

Mother dx during pregnancy (26 cases)

Mother dx before pregnancy (15 cases)

62% of transmissions were in infants born to women undiagnosed by time of delivery

108 infants diagnosed with HIV infection

and reported to NSHPC by April 2014*

* 25 further

cases reported

since April 2014

Recent NSHPC publications

For a full list of publications, visit www.ucl.ac.uk/nshpc/publications.

EthicsMREC/04/2/009; CAG ref: 15/CAG/0190

Current funding

Public Health England

NHS Infectious Diseases in Pregnancy Screening Programme

Any views expressed in NSHPC publications / presentations are those of the authors or presenters and not necessarily those of the funders.

Visit the National Surveillance of HIV in Pregnancy and Childhood (NSHPC) website at www.ucl.ac.uk/nshpc.

Current team

Principal Investigator: Claire Thorne

Co-investigators: Pat Tookey, Mario Cortina-Borja

Surveillance Manager: Helen Peters

Surveillance Coordinator: Kate Francis

Surveillance Assistants: Laurette Bukasa, Rebecca Sconza

Surveillance Administrator: Anna Horn

PhD Student: Virginia Rasi

Acknowledgements

All NSHPC respondents

Public Health England and Health Protection Scotland

British Paediatric Surveillance Unit (RCPCH) and respondents

Contributors to the Collaborative HIV Paediatric Study (CHIPS) at the MRC Clinical Trials Unit and the clinical centres