Townsend, C.L.; (2009) Antiretroviral therapy and pregnancy outcome in HIV-infected women in the United Kingdom and Ireland. Doctoral thesis , UCL (University College London).

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Abstract

The aim of this thesis is to explore pregnancy and perinatal outcomes in diagnosed HIV-infected women receiving antiretroviral therapy (ART) in the UK (United Kingdom) and Ireland. Population-based surveillance data on HIV-infected pregnant women and their children is collected through the National Study of HIV in Pregnancy and Childhood (NSHPC), which includes information on over 8000 pregnancies delivered between 1990 and 2007. The majority of diagnosed infected women now take highly active antiretroviral therapy (HAART) in pregnancy, which reduces the risk of mother-to-child HIV transmission. However, there have been concerns over the potential for maternal and fetal adverse effects, with conflicting findings from European and American studies regarding the association between HAART and premature delivery. In this thesis, trends over time in the demographic characteristics of HIV-infected pregnant women in the UK and Ireland are described, along with changes in the uptake of interventions for preventing mother-to-child transmission. Transmission rates are explored over a period when HAART was routinely available, and subgroups of women managed in the context of regularly updated national guidelines are compared with respect to their risk of transmission. Multivariable logistic regression models are used to assess the association between type of ART exposure in pregnancy and adverse outcomes including pre-eclampsia, prematurity, stillbirth, neonatal death and congenital abnormality. In addition, using data from the European Collaborative Study and the Pediatric Spectrum of HIV Disease project alongside the UK and Ireland data, the effects of differences in populations and methodologies (study design and analytical approach) on the observed association between HAART and premature delivery are investigated, and a pooled analysis of individual motherchild pairs is carried out. Finally, the risks and benefits of ART in terms of adverse pregnancy outcomes and mother-to-child transmission were jointly modelled using Monte Carlo simulation methods, to produce a risk-benefit ratio.

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