VERTICALLY TRANSMITTED HIV-INFECTION IN THE BRITISH-ISLES

Objective-To describe the epidemiology of vertically acquired HIV infe ction in the British Isles, the level of underreporting, the vertical transmission rate, and clinical spectrum of paediatric AIDS. Design--C onfidential, linked registers based on reporting from obstetricians an d paediatricians; anonymous unlinked neonatal HIV serosurveys. Setting -British Isles. Subjects-Children born to mothers with HIV infection. Main outcome measures-Trends in HIV infection and vertical transmissio n rate. Results-In Scotland and the Irish Republic, where most materna l HIV infection is related to drug misuse, the annual number of report s of children born to infected mothers has fallen since 1989. In Engla nd and Wales nearly half of maternal infections have been acquired ove rseas, and the number of children born to these women, and to women wh o became infected in Britain, is increasing. In south east England the proportion of live births to women whose infection was identified bef ore delivery was only 17% (50/287), compared with 68% (26/38) in Scotl and. The vertical transmission rate was 13.7% (23/168), and 23% of inf ected children developed AIDS in the first year of life. 41% (38/92) o f children born to infected mothers who were ascertained after deliver y were breast fed, compared with 5% (12/236) of those ascertained befo re delivery. Conclusions-The incidence of vertically transmitted HIV i nfection is increasing in England and Wales. More extensive antenatal testing would enable infected women to be counselled against breast fe eding, which could prevent a substantial proportion of vertical transm ission in some areas, and would increase opportunities for early diagn osis and treatment of infected children.