Byrne, Laura;
(2022)
Antiretroviral therapy, drug resistance in pregnancy, and preventing mother-to-child HIV transmission in the UK.
Doctoral thesis (Ph.D), UCL (University College London).
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Abstract
Effective interventions have reduced the HIV vertical transmission rate in high-income countries to very low levels; the goal is now to eliminate new paediatric HIV infections. The aim of this thesis was to examine the role of antiretroviral therapy (ART) and other interventions to reduce vertical HIV transmission in the UK and Ireland in the current treatment era. I used data from the National Study of HIV in Pregnancy and Childhood (NSHPC), a national surveillance study of all pregnancies in women living with HIV and their children in the UK and Ireland; the UK HIV drug resistance database and a national survey on the management of women who decline antenatal HIV testing. The NSHPC dataset included all pregnancies reported 2000-2014. Results highlight substantial changes in the demographics of women with reported pregnancies. There was wide variation in the management of women who decline HIV testing in pregnancy. Women with perinatal HIV in the UK had a first pregnancy incidence of 13 per 1000 woman-years (95% CI: 9 to 17 per 1000 woman-years). Perinatal HIV was an independent risk factor for detectable viral load near delivery (aOR 3.22 95% CI: 1.22-8.48), as was lower age at conception, no ART at conception, and PI-containing cART. The prevalence of transmitted drug resistance was 5.3% in women diagnosed during pregnancy (95% CI: 4.3% to 6.5%), similar to other estimates in non-B HIV-1 subtypes in the UK. Key contributing factors were identified in the 108 cases of perinatal HIV in infants born in the UK 2006-2014, including women who declined HIV testing in pregnancy; difficulties with engagement and adherence to ART during pregnancy; HIV acquisition during pregnancy or postnatal period after a negative test in early pregnancy. This thesis identifies key improvements which can still be made on the road to eliminating paediatric HIV.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | Ph.D |
| Title: | Antiretroviral therapy, drug resistance in pregnancy, and preventing mother-to-child HIV transmission in the UK |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Copyright © The Author 2022. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| UCL classification: | UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL |
| URI: | https://discovery-pp.ucl.ac.uk/id/eprint/10146164 |
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