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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