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P21 PAEDIATRIC HIV INFECTION FOLLOWING SEROCONVERSION IN PREGNANCY DESPITE ANTENATAL SCREENING

S. S. Struik1, presenting, G. Tudor-Williams2, G. P. Taylor2, S. D. Portsmouth2, C. J. Foster2, C. Walsh1, C. Hanley1, S. Walters1, J. H. Smith1, H. Lyall1.1St Mary’s Hospital, London; 2Imperial College of Medicine, London, UK

Introduction: Should partners be tested and/or repeat third trimester HIV screening be recommended?

Aims: To demonstrate that seroconversion in pregnancy is an important cause of vertically transmitted HIV in the UK. To highlight the need for further regional and national investigation of this problem and for a review of the UK policy of prevention of vertically transmitted HIV.

Methods: Retrospective case note review of all infants diagnosed with HIV below 1year of age between 1 January 2001 and 31 December 2005 in a tertiary referral hospital in London providing family centred care for HIV (n = 25).

Results: Twenty two of the 25 cases received antenatal care in the UK. Five infected infants were born to mothers who had negative HIV tests on antenatal booking between 10 and 18 weeks gestation, implying seroconversion during pregnancy. Of these, three occurred in 2005. They all presented with AIDS defining illnesses between the ages of 3–9 months. Two infants died, two sustained marked neurological sequelae and one appears has made an intact recovery at 11 months of age.

Conclusions: Since the introduction of universal HIV screening at antenatal booking in 1999, we are increasingly observing HIV seroconversion in pregnancy leading to infant AIDS. This might reflect the rising incidence of new HIV in the UK and/or increased recognition of seroconversions, now that screening at booking successfully identifies most established infections. A negative antenatal test does not preclude an AIDS diagnosis in a sick …

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