Pregnancy outcomes in HIV infected women in the United Kingdom
Lead Research Organisation:
University College London
Department Name: UNLISTED
Abstract
Diagnosis of HIV positive women in pregnancy means that they can reduce the risk of infecting their babies to less than 2% with anti-HIV drugs (antiretrovirals). However, these drugs may have unwanted side effects, including premature delivery.
In the UK and Ireland, all pregnant women are offered HIV testing, and most accept. HIV rates have increased recently to about 2 per 1000 pregnant women. Almost all infected women take antiretroviral therapy in pregnancy.
Information on HIV positive pregnant women is collected routinely through the National Study of HIV in Pregnancy and Childhood. This allows us to explore the association between HIV treatment in pregnancy and issues such as premature delivery, birth defects and mother-to-child transmission of the virus.
In some, but not all, studies antiretroviral therapy is associated with an increased risk of premature delivery. We want to explore the reasons for these different findings by looking at three studies. We will try to discover if these differences are due to the way the studies are designed and analysed, or other reasons.
We hope that a clear understanding of HIV treatment and adverse effects in pregnancy will lead to better outcomes in HIV positive women and their children.
In the UK and Ireland, all pregnant women are offered HIV testing, and most accept. HIV rates have increased recently to about 2 per 1000 pregnant women. Almost all infected women take antiretroviral therapy in pregnancy.
Information on HIV positive pregnant women is collected routinely through the National Study of HIV in Pregnancy and Childhood. This allows us to explore the association between HIV treatment in pregnancy and issues such as premature delivery, birth defects and mother-to-child transmission of the virus.
In some, but not all, studies antiretroviral therapy is associated with an increased risk of premature delivery. We want to explore the reasons for these different findings by looking at three studies. We will try to discover if these differences are due to the way the studies are designed and analysed, or other reasons.
We hope that a clear understanding of HIV treatment and adverse effects in pregnancy will lead to better outcomes in HIV positive women and their children.
Technical Summary
The prevalence of HIV infection in pregnant women in the United Kingdom (UK) is increasing, and many women are now diagnosed during antenatal care. With the widespread use of antiretroviral therapy (ART) during pregnancy, there have been concerns over the potential for adverse effects, with different findings from European and American studies regarding prematurity risk.
The aim of this project is to evaluate pregnancy outcome in HIV infected women receiving ART in the UK, using national surveillance data. The project will focus on the association between ART and prematurity, congenital abnormalities, mother-to-child transmission and other pregnancy complications. An appropriate pooled analysis on prematurity including data from two other large-scale studies (in Europe and the United States) will be carried out, and results and methodologies of the three studies will be compared. A further aim of this project is to assess the completeness of the UK surveillance scheme, in order to validate its status as a population-based study. This exercise will be based on internal comparisons, but will also rely on antenatal detection data collected by the Health Protection Agency. Finally, models will be developed to predict the future burden on the health services from adverse outcomes related to ART.
This project is based on the National Study of HIV in Pregnancy and Childhood (NSHPC), the ongoing national surveillance system. HIV infected women and children in the UK and Ireland, and children born to infected women are reported to the NSHPC through complementary schemes. Information is collected on maternal demographics, ART, pregnancy outcome and infant‘s infection status. This project will also incorporate data from the European Collaborative Study and the Pediatric Spectrum of Diseases Study in the USA for a pooled analysis with the NSHPC data.
Information on over 6000 pregnancies has been collected through the NSHPC since the late 1980s, with over 1000 new pregnancies now added annually. This unique dataset is not fully exploited at present, and provides a tremendous opportunity for further research. This fellowship will allow important additional analyses and will enable a full assessment of the comprehensiveness of the surveillance, an exercise which has not previously been performed. Results of these analyses will inform national guidelines for the management of HIV infected women, and will help midwives and obstetricians provide better quality care for infected women.
The aim of this project is to evaluate pregnancy outcome in HIV infected women receiving ART in the UK, using national surveillance data. The project will focus on the association between ART and prematurity, congenital abnormalities, mother-to-child transmission and other pregnancy complications. An appropriate pooled analysis on prematurity including data from two other large-scale studies (in Europe and the United States) will be carried out, and results and methodologies of the three studies will be compared. A further aim of this project is to assess the completeness of the UK surveillance scheme, in order to validate its status as a population-based study. This exercise will be based on internal comparisons, but will also rely on antenatal detection data collected by the Health Protection Agency. Finally, models will be developed to predict the future burden on the health services from adverse outcomes related to ART.
This project is based on the National Study of HIV in Pregnancy and Childhood (NSHPC), the ongoing national surveillance system. HIV infected women and children in the UK and Ireland, and children born to infected women are reported to the NSHPC through complementary schemes. Information is collected on maternal demographics, ART, pregnancy outcome and infant‘s infection status. This project will also incorporate data from the European Collaborative Study and the Pediatric Spectrum of Diseases Study in the USA for a pooled analysis with the NSHPC data.
Information on over 6000 pregnancies has been collected through the NSHPC since the late 1980s, with over 1000 new pregnancies now added annually. This unique dataset is not fully exploited at present, and provides a tremendous opportunity for further research. This fellowship will allow important additional analyses and will enable a full assessment of the comprehensiveness of the surveillance, an exercise which has not previously been performed. Results of these analyses will inform national guidelines for the management of HIV infected women, and will help midwives and obstetricians provide better quality care for infected women.