Reducing vertical transmission of HIV in the UK

Papers pp 1227, 1230 For five years we have known that administering zidovudine to HIV infected women during pregnancy and in labour, and to the neonate for the first 6 weeks of life, greatly reduces mother to child transmission of HIV.1 This intervention, together with delivery by caesarean section and avoiding breast feeding, has reduced the risk of transmission from over 20% to well under 5%.2 In the United States, where antiretroviral therapy is widely used to reduce perinatal transmission, the incidence of AIDS in infants, a sensitive indicator of mother to child transmission, has fallen by 80%.3 In the United Kingdom, although routine antenatal testing for HIV infection has officially been recommended for high prevalence areas since 1994, most maternal HIV infections remain undetected.4 Thus the number of infants presenting with AIDS in the UK has not declined, as it has in other European countries, and in 1997 was higher than in France, Italy, or Spain. Yet these countries have adult HIV burdens four or more times greater than that of the UK.5 In 1997 the unlinked anonymous programmes of HIV testing found evidence of 265 births to HIV infected women, 195 …