Abstract
BackgroundNearly all HIV infections in children worldwide are acquired through mother-to-child transmission (MTCT) during pregnancy, labour, delivery or breastfeeding. The objective of our study was to estimate the number and rate of new HIV diagnoses in children less than 13 years of age in mainland France from 2003–2006.MethodsWe performed a capture-recapture analysis based on three sources of information: the mandatory HIV case reporting (DOVIH), the French Perinatal Cohort (ANRS-EPF) and a laboratory-based surveillance of HIV (LaboVIH). The missing values of a variable of heterogeneous catchability were estimated through multiple imputation. Log-linear modelling provided estimates of the number of new HIV infections in children, taking into account dependencies between sources and variables of heterogeneous catchability.ResultsThe three sources observed 216 new HIV diagnoses after record-linkage. The number of new HIV diagnoses in children was estimated at 387 (95%CI [271–503]) from 2003–2006, among whom 60% were born abroad. The estimated rate of new HIV diagnoses in children in mainland France was 9.1 per million in 2006 and was 38 times higher in children born abroad than in those born in France. The estimated completeness of the three sources combined was 55.8% (95% CI [42.9 – 79.7]) and varied according to the source; the completeness of DOVIH (28.4%) and ANRS-EPF (26.1%) were lower than that of LaboVIH (33.3%).ConclusionOur study provided, for the first time, an estimated annual rate of new HIV diagnoses in children under 13 years old in mainland France. A more systematic HIV screening of pregnant women that is repeated during pregnancy among women likely to engage in risky behaviour is needed to optimise the prevention of MTCT. HIV screening for children who migrate from countries with high HIV prevalence to France could be recommended to facilitate early diagnosis and treatment.
Highlights
Most HIV infections in children worldwide are acquired through mother-to-child transmission (MTCT) during pregnancy, labour, delivery or breastfeeding
Case definition Cases were defined as all new HIV infections in children under 13 years of age, according to microbiological criteria [4], that were diagnosed in mainland France during the 2003–2006 period
Capture-recapture estimates When performing two-source capture-recapture analysis, the estimate of the number of new HIV diagnoses provided by matching the sources DOVIH and EPF (Nest = 188; 95%confidence intervals (CI) [171 – 206]) was lower than the estimate provided by matching laboratory-based surveillance of HIV (LaboVIH) and EPF (Nest = 261; 95%CI [224–297]) or LaboVIH and DOVIH (Nest = 330; 95%CI [272–389]), suggesting a positive dependence between the sources DOVIH and EPF
Summary
Most HIV infections in children worldwide are acquired through mother-to-child transmission (MTCT) during pregnancy, labour, delivery or breastfeeding. The objective of our study was to estimate the number and rate of new HIV diagnoses in children less than 13 years of age in mainland France from 2003–2006. Most HIV infections that occur worldwide in children are acquired through mother-to-child transmission (MTCT) during pregnancy, labour, delivery or breastfeeding. Estimates have shown that there were nearly 430,000 new paediatric infections worldwide in 2008 [1]. In France, the risk of HIV transmission from mother to child has been dramatically reduced since the end of the 1980s through the prophylactic use of antiretroviral therapy (ART) during pregnancy and the administration of ART drugs to the baby during the first weeks of life. In France, the national policy since 1993 has been to offer universal voluntary HIV testing in the first trimester of pregnancy
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