A Retrospective Study of the Management of HIV, Hepatitis B and Hepatitis C-Positive Pregnancies in Edinburgh, UK from 1997-2002.
STUDY AIMS: This study aims to examine management practices for HIV-positive, HBV-positive and HCV-positive pregnancies over 1997-2002 in Edinburgh, UK, and the effects the diseases have on pregnancy outcomes. RESULTS: Equally for HIV, HBV, and HCV, 50% of the diagnoses were made before pregnancy while the other 50% were detected and diagnosed through antenatal testing. Of the 17 HBV-positive pregnancies 31.6% of the women were highly infectious at delivery and 57.9% were carriers with low infectivity. Of the 17 HIV-positive pregnancies 47.1% of the women had an undetectable viral load and 17.6% were unrecorded at delivery. All 17 HIV-positive pregnancies received ART in varying regimes, 15 (88.2%) were on combination therapy, one delivered vaginally and no women breastfed. All neonates of HBV-positive mothers received immunoglobulin and vaccination and were then breastfed. There were no specific interventions for HCV. Only one study child out of the 38 pregnancies became infected, and this was with HIV. CONCLUSION: Routine screening identifies women with no obvious risk factors, and interventions are largely accepted and effective at reducing vertical transmission. HIV therapy is individually tailored and increasingly uses several agents. Moreover, there is a movement towards allowing low viral load HIV-positive women to deliver vaginally. There are no interventions recommended for HCV infectivity alone. The difficulty collecting information illustrates that no adequate tracking system of infected pregnant women exists. Recommended is the creation of a formal database that includes standardized information such as the viral load of HIV or HCV at delivery, so that outcomes of intrapartum management can be more effectively assessed. No comment can be made on virus-related pregnancy complications, as study numbers are too small for statistically valid data.
- Duong T, Ades AE, Gibb DM, Tookey PA, Masters J. Vertical transmission rates for HIV in the British Isles: estimates based on surveillance data. BMJ 1999; 319:1227-29.
- Gibb DM, Duong T, Tookey PA et al. Decline in mortality, AIDS, and hospital admissions in perinatally HIV-1 infected children in the United Kingdom and Ireland. BMJ 2003; 327(7422):1019.
- Stevens CE, Neurath RA, Beasley RP, Szmuness W, HBeAg and anti-Hbe detection by radioimmunoassay: correlation with vertical transmission of hepatitis B virus in Taiwan. J Med Virol 1979; 3: 237-41.
- British National Formulary. Issue 46. September 2003
- National Institutes of Health Fiscal Year 2003: Plan for HIV related research URL: http://www.nih.gov/od/oar/public/pubs/fy2003/ i_overview.pdf
- Scottish Centre for Infection and Environmental Health Weekly Report: 25 June 2002; Volume 36, No. 2002/25. ISSN 1357-4493. p.156.
- Kuhn L, Steketee RW, Weedon J et al. Distinct risk factors for intrauterine and intrapartum human immunodeficiency virus transmission and consequences for disease progression in infected children. Perinatal AIDS Collaborative Transmission Study. J Infectious Diseases 1999; 179(1): 52-58.
- Public Health Laboratory Service: HIV and AIDS: Surveillance URL:http://www.phls.org.uk/topics_az/hiv_and_sti/hiv /epidemiology/ quarterly.htm
- Communicable disease surveillance centre: HIV and AIDS in the UK. An epidemiological review: 2000.
- Dunn et al. Mode of delivery and vertical transmission of HIV- 1: a review of prospective studies. Perinatal AIDS Collaborative Transmission Studies. J Acquir Immune Defic Syndr 1994; 7(10):1064-66.
- Connor EM et al. Reduction of maternal-infant transmission of Human Immunodeficiency Virus Type 1 with zidovudine treatment. N Engl J Med 1994; 331:1173-80.
- The International Perinatal HIV Group. The mode of delivery and the risk of vertical transmission of Human Immunodeficiency Virus type 1- A meta-analysis of 15 prospective cohort studies. N Engl J Med 1999; 340: 977-87.
- Moyes CD, Smith L, Lennon D. Hepatitis B - prevention of perinatal transmission. NZ Med J 2002; 115:19-20.
- Obstetrics. In: Collier J, Longmore M, Brown TD. Oxford Handbook of Clinical Specialities. 5th ed. Oxford University Press; 2001. p.76-169.
- Hill JB, Sheffield JS, Kim MJ, Alexander JM, Sercely B, Wendel GD. Risk of hepatitis B transmission in breast-fed infants of chronic hepatitis B carriers. Obstet Gynecol 2002; 99(6): 1049-52.
- WHO Consultation and the Viral Hepatitis Prevention Board. Global surveillance and control of hepatitis C. J Viral Hepatitis 1999; 6(1): 35-47.
- Conte D, Fraquelli M, Prati D, Colucci A, Minola E. Prevalence and clinical course of chronic hepatitis C virus (HCV) infection and rate of HCV vertical transmission in a cohort of 15,250 pregnant women. Hepatology 2000; 31(3): 751-5.
- Garland SM et al. Hepatits C - role of perinatal transmission. Aust NZ Obstet Gynaecol 1998; 38(4): 424-7.
- Resti M, Azzari C, Bortolotti F. Hepatitis C virus infection in children coinfected with HIV: epidemiology and management. Paediatric Drugs 2002; 4(9): 571-80.
- European Paediatric Hepatitis C Virus Network. Effects of mode of delivery and infant feeding on the risk of mother-to-child transmission of hepatitis C virus. Brit J Obstet & Gynaecol 2001; 108: 371-7.
- Tovo PA et al. Increased risk of maternal-infant hepatitis C virus transmission for women coinfected with human immunodeficiency virus type 1. Italian Study Group for HCV Infection in Children. Clin Infect Dis 1997; 25(5): 1121-4.
- Thomas SL, Newell ML, Peckham CS, Ades AE, Hall AJ. A review of hepatitis C virus (HCV) vertical transmission: risks of transmission to infants born to mothers with and without HCV viraemia or human immunodeficiency virus infection. Int J Epidemiol 1998; 27(1):108.
- Ohto H et al. Transmission of hepatitis C virus from mothers to infants. N Engl J Med 1994; 330:744-50.
- Tuomala RE et al. Antiretroviral therapy during pregnancy and the risk of an adverse outcome. N Engl J Med 2002; 346: 1863- 70.
- Culnane M et al. Lack of long-term effects on in utero exposure to zidovudine among uninfected children born to HIV-infected women. JAMA 1999; 281:151-7.
Download data is not yet available.
Douglas G. Chang, M.S.,
Martin T. Stein, M.D.,
David A. Sine, M.D.,
David W. Yeung, M.B.B.S., F.C.C.P. ,
Frank L. Mannino, M.D.,
Reversible Neonatal Cholestasis Following In Utero Exposure to Valproic Acid
McGill Journal of Medicine: Vol. 2 No. 2 (1996)
Som Prabh Singh,
Mechanisms of action by antimicrobial agents: A review
McGill Journal of Medicine: Vol. 19 No. 1 (2021)
You may also start an advanced similarity search for this article.