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Title: Sequential pregnancies among women living with HIV in the United Kingdom and Ireland
Author: French, C. E.
Awarding Body: University College London (University of London)
Current Institution: University College London (University of London)
Date of Award: 2014
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This thesis investigates the epidemiology of sequential pregnancies among HIV-positive women in the United Kingdom and Ireland, and explores the health, therapeutic and obstetric management, and pregnancy outcomes, of the women experiencing them. Data from the UK and Ireland’s National Study of HIV in Pregnancy and Childhood (NSHPC) are analysed. This is a well-established, active, comprehensive national surveillance study with over 1500 pregnancies currently reported each year. The findings demonstrate that a substantial and increasing proportion of pregnancies are women’s second or subsequent since their HIV diagnosis (39% in 2009), with a rate of 6.7 (95% CI: 6.5-6.9) per 100 woman-years during 1990-2009. Analyses revealed potential missed opportunities for the timely initiation of antiretroviral therapy (ART) in this group of previously diagnosed women, both within and outside the context of pregnancy. Variations in women’s engagement with HIV and pregnancy-related care are explored. In the contemporary context of effective prevention of mother-to-child transmission (PMTCT) interventions there are unanswered questions around the optimal management of HIV-positive women of childbearing age. Exposure to short-course protease inhibitor-based combination ART for PMTCT did not impact on response to therapy in subsequent pregnancies, supporting current UK recommendations. However, analyses of the immunological status and virological outcomes in second pregnancies to women not on ART at conception suggest that initiating lifelong ART in pregnancy may have benefits for maternal health and the risk of vertical transmission in future pregnancies. Adverse pregnancy and perinatal outcomes are investigated among women’s repeat pregnancies, which were for example, more likely to be conceived on ART than index pregnancies. Finally, patterns in mode of delivery for women’s sequential births are explored. The analyses presented in this thesis inform the evidence-base for the effective management of HIV-positive women in the context of current and potential future pregnancies.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available