Sexual and reproductive health in a UK cohort of young adults perinatally infected with HIV

Croucher, Adam; José, Sophie; McDonald, Susan; Foster, Caroline; Fidler, Sarah

doi:10.1136/sextrans-2012-050831

Cited by 14 publications

(20 citation statements)

References 7 publications

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“…There have been several studies in the USA: one multicentre cohort study found lower rates of sexual activity in young people with PHIV compared with those with BHIV, with sexual activity more likely in those older, those with a boyfriend or girlfriend, and those using illicit drugs [26]; however, a smaller single-centre study found similar sexual risk behaviours in young people with PHIV and those with BHIV [27], whereas another cohort comparing young people with PHIV to those HEU found a lower proportion sexually active in the former, but this did not reach statistical significance [28]. In the United Kingdom, one single-centre cohort reported that 78% of young people with PHIV aged 16–25 were sexually active [29], and the adolescents and adults living with perinatal HIV cohort reported lower sexual activity in adolescents with PHIV compared with HIV-negative adolescents [30]. A qualitative study of young people with PHIV showed a high rate of procreational intent, likely reflecting perceived improvements in HIV treatment and MTCT risk [31].…”

Section: Discussionmentioning

confidence: 99%

Pregnancy incidence and outcomes in women with perinatal HIV infection

Byrne

Sconza

Foster

et al. 2017

Aids

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Objectives:To estimate the incidence of first pregnancy in women living with perinatally acquired HIV (PHIV) in the United Kingdom and to compare pregnancy management and outcomes with age-matched women with behaviourally acquired HIV (BHIV).Design:The National Study of HIV in Pregnancy and Childhood is a comprehensive, population-based surveillance study that collects demographic and clinical data on all pregnant women living with HIV, their children, and all HIV-infected children in the United Kingdom and Ireland.Methods:The incident rate ratio of first pregnancy was calculated for all women of reproductive age who had been reported to the National Study of HIV in Pregnancy and Childhood as vertically infected children. These women and their pregnancies were compared to age-matched pregnant women with BHIV.Results:Of the 630 women with PHIV reported in the United Kingdom as children, 7% (45) went on to have at least one pregnancy, with 70 pregnancies reported. The incident rate ratio of first pregnancy was 13/1000 woman-years. The BHIV comparison group comprised 118 women (184 pregnancies). Women with PHIV were more likely to be on combined antiretroviral therapy at conception and have a lower baseline CD4+ cell count (P < 0.01 for both). In adjusted analysis, PHIV and a low baseline CD4+ cell count were risk factors for detectable viral load near delivery; older age at conception and being on combined antiretroviral therapy at conception reduced this risk.Conclusion:Women with PHIV in the United Kingdom have a low pregnancy incidence, but those who become pregnant are at risk of detectable viral load near delivery, reflecting their often complex clinical history, adherence, and drug resistance issues.

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Section: Discussionmentioning

confidence: 99%

Pregnancy incidence and outcomes in women with perinatal HIV infection

Byrne

Sconza

Foster

et al. 2017

Aids

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“…As the UK cohort has aged, the emphasis of care has now shifted to the management of adherence, complex resistance, transition of care to adult services, long-term drug toxicity and sexual and mental health 17 18. Issues of fertility are becoming relevant as the older adolescents enter young adulthood with completed pregnancies now reported in young women with perinatally acquired HIV 19…”

Section: The Uk Paediatric Hiv Cohort In 2014mentioning

confidence: 99%

Paediatric HIV grows up: recent advances in perinatally acquired HIV

Bamford

Lyall

2014

Arch Dis Child

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This review is an update focusing on the current status of paediatric HIV in the UK and Ireland. Successes in prevention of mother to child transmission are highlighted. The changing epidemiology of the UK cohort is summarised and the shift in emphasis of treatment guidelines beyond limiting short-term morbidity and mortality to ensuring optimal health status in adult life is discussed. Current and future challenges relating to an aging cohort, successful transition to adult services and the prospect of a lifetime on antiretroviral therapy (ART), as well as the possibility of ART-free survival are also considered. While numbers of HIV-infected children in the UK are now decreasing, lessons we have learned in the last 30 years from this relatively small cohort are increasingly applicable to the global paediatric HIV population.

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“…Following the widespread use of combination antiretroviral therapy (cART), children with perinatally acquired HIV-1 infection are surviving into adolescence and entering sexual relationships with their HIV-negative peers who may present with post-exposure prophylaxis following sexual exposure (PEPSE) 5. The British Association of Sexual Health and HIV (BASHH) have recently updated their PEPSE guidelines.…”

Section: Introductionmentioning

confidence: 99%

Post-exposure prophylaxis guidelines for children and adolescents potentially exposed to HIV

2016

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UK guidelines for HIV post-exposure prophylaxis (PEP) in adults have recently been updated. Indications for PEP have been modified and there has been a change in the recommended antiretroviral therapy for adults to a combination of raltegravir with tenofovir and emtricitabine (Truvada). Raltegravir and tenofovir are now available in paediatric formulations and offer improved safety and tolerability over previously recommended ritonavir-boosted lopinavir with zidovudine. This guideline provides recommendations for those caring for children potentially exposed to HIV and other bloodborne viruses in primary care, emergency departments, secondary care and specialist paediatric HIV centres.

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Sexual and reproductive health in a UK cohort of young adults perinatally infected with HIV

Abstract: The majority of our cohort was sexually active while still under the care of paediatric health services. Cervical screening and hepatitis B vaccination rates fell short of audit standards. Vaccination for hepatitis B should be considered prior to transfer of care to adult HIV services.

Cited by 14 publications

References 7 publications

Pregnancy incidence and outcomes in women with perinatal HIV infection

Pregnancy incidence and outcomes in women with perinatal HIV infection

Paediatric HIV grows up: recent advances in perinatally acquired HIV

Post-exposure prophylaxis guidelines for children and adolescents potentially exposed to HIV

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