Bukasa, Laurette L; (2024) Epidemiology of birth, cancer and mortality outcomes of children born HIV-free to women living with HIV in England 2002-2019. Doctoral thesis (Ph.D), UCL (University College London).

Text Laurette Bukasa - thesis - 16.09.2024.pdf - Accepted Version Access restricted to UCL open access staff until 1 October 2025. Download (7MB)

Abstract

Women living with HIV (WLWH) are treated with antiretroviral therapy (ART) in pregnancy for their own health and to prevent vertical transmission, resulting in fewer paediatric infections. The population of children born HIV-free has increased over time and is estimated to be 16 million globally. Some evidence suggests that children born HIV-free have poorer birth, morbidity, and mortality outcomes than children who are HIV-unexposed. The evidence base for the effect of HIV/ART exposures in utero is growing but remains relatively limited in low-burden and resource-rich settings. This thesis aimed to investigate early life exposures and birth, cancer and mortality outcomes of children born HIV-free in the context of evolving HIV treatment guidelines, maternal and pregnancy factors, utilising population level surveillance data from pregnant WLWH and their infants in England, including a nested longitudinal cohort of linked surveillance and civil registration data. One in three (28.7%) children born HIV-free had sub-optimal birth outcomes and the most important risk factors were diabetes and hypertensive disorders, both of which increased in prevalence over time affecting up to 10% of children in 2019. Newer antiretrovirals rilpivirine and raltegravir were associated with large infant outcomes. Linking surveillance data to national data sources on cancers and deaths was successful for 84% of children born HIV-free and there were no differences in cancer or mortality outcomes compared to the general population. Key risk factors for cancer and mortality included congenital anomalies. Predictors for mortality included preterm-small for gestational age, first maternal viral load and ART exposures to ritonavir boosted lopinavir and atazanavir. These findings demonstrate that the vulnerabilities of children born HIV-free to poor outcomes are predominantly driven by universal risk factors and the contribution of ART remains difficult to interpret. Optimising outcomes in children will involve reducing maternal risk factors for comorbidities and enhanced long-term monitoring.

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