Neonatal deaths of infants born to women living with HIV in the UK and Ireland, 1998–2017: a retrospective case note review

Abstract

BackgroundSuccessful prevention strategies have driven the decline of the vertical transmission rate of HIV in the UK and Ireland from 2·1% in 2000–01, to 0·27% in 2012–14. Concerns remain regarding other adverse outcomes including neonatal death in infants born to women living with HIV. This study aimed to investigate neonatal deaths and associated risk factors in this population in the UK and Ireland. MethodsData were drawn from the National Surveillance of HIV in Pregnancy and Childhood (NSHPC), which collects comprehensive, population-based data from all maternity and paediatric units across the UK and Ireland; completeness is estimated at more than 95%. Estimated yearly incidence of neonatal death was reported for 1998–2017, and causes were coded using WHO ICD-PM classification. Risk factor analysis used multivariable logistic regression, including delivery year, maternal origin, maternal age, delivery CD4 count and viral load, antiretroviral therapy (ART) at conception, injecting drug use, and infant sex. FindingsIn 1998–2017, there were 20 012 liveborn infants to 12 684 women living with HIV. The overall neonatal death rate was 4·1 per 1000 livebirths (95% CI 3·2–5·0), compared with an average of 3·24 in the general population (1998–2016). Prematurity was the leading cause of death followed by congenital abnormality. ART at conception was associated with reduced risk of neonatal death (adjusted odds ratio [aOR] 0·57, 95% CI 0·30–0·99). In an analysis restricted to 2007–17, delivery year (aOR 1·18, 1·03–1·34, per additional year) and detectable delivery viral load (8·14, 3·46–19·17) were associated with increased risk of neonatal death; aOR of neonatal death for mothers aged 40 years or older was 1·40 (0·54–3·58) compared with those aged 24–39 years (p=0·49), consistent with the general population. InterpretationWomen living with HIV have a higher rate of neonatal death than that reported for the general population, with indications that this risk may have increased in recent years. This finding is concerning and highlights continuing need to monitor neonatal death and its main cause, preterm delivery. Detectable viral load was associated with increased risk of neonatal death, and ART use at conception might reduce risk. Maternal substance use and weight were not collected and thus not included in analyses. Wide confidence intervals were observed reflecting small numbers of events. Maternal viral load suppression through effective ART will improve maternal health, prevent vertical transmission, and might reduce neonatal death. FundingPublic Health England.