HIV, hepatitis and pregnancy

An estimated 0.14% of pregnant women in the UK are HIV-infected overall, rising to 2% among women from sub-Saharan Africa living in London. Mother-to-child transmission (MTCT) of HIV can occur in utero, intrapartum and through breastfeeding. Antiretroviral therapy, elective Caesarean section and formula-feeding can significantly reduce MTCT risk; where infected women are identified before or in pregnancy and have access to these interventions, MTCT risk is now around 1-2%, compared to 15-40% without interventions. Antenatal HIV testing should therefore be recommended universally, to allow optimum application of MTCT interventions and timely clinical management of infected women. Although limited safety data are available on antenatal use of antiretrovirals, the known benefits of antiretroviral prophylaxis outweigh the theoretical risks. The antenatal prevalence of hepatits C virus (HCV) infection in the UK is estimated to be below 1%. Risk of MTCT of HCV is around 3-5%, reaching up to 15% in women co-infected with HIV. Current evidence does not suggest a benefit of elective Carsarean section for HCV-infected women in terms of prevention of MTCT, nor a need to refrain from breastfeeding, with the exception of HIV/HCV co-infected women; no therapeutic prophylaxis for prevention of MTCT of HCV is currently available. Unlike HCV infection, hepatits B virus (HBV) infection has a high risk of MTCT, with potentially serious long-term impact on the child; however, unlike the former, transmission of HBV can be effectively prevented with immune prophylaxis. In the UK, routine screening of all pregnant women for HBV but not for HCV is currently recommended