In 2011, the survey covered about 400 000 births, and estimated HIV prevalence was 2.2 per 1000 women giving birth. Prevalence in London was 4 per 1000 in 2002, peaked at 4.5 per 1000 in 2003, and has declined a little since then to 3.5 per 1000 in 2011. In the rest of England prevalence was about 0.7 per 1000 in 2002, rising to 1.5 per 1000 by 2006, and reaching 1.6 per 1000 in 2011. In Scotland prevalence increased from about one in 2150 in 2000 to one in 1150 in 2008 [1, 2]. The majority of HIV-positive pregnant women are from sub-Saharan Africa with overall prevalence relatively

stable over the last 10 years at 2–3%, although sub-Saharan African women giving birth in London had a lower seroprevalence (1.8%) than those giving birth elsewhere in England (3.2%). Although prevalence PD-166866 mouse among UK-born women giving birth remained low at about 0.5 per 1000 women in 2011, there was a gradual increase over the decade from 0.3 per 1000 in 2002 [2]. In the UK, the rate of HIV MTCT from diagnosed women was 25.6% in 1993

at which time interventions were virtually non-existent [3]. Between 2000 and 2006, with high uptake of interventions, the overall transmission rate from diagnosed women was 1.2%, and less than 1% among women who had received at least 14 days of ART. Among more than 2000 women who had received cART and delivered with an undetectable viral load, there were only three transmissions, an MTCT rate of 0.1% [4]. These very low transmission rates persist, and were even lower in 2007–2011 at an estimated 0.57% [5]. A small 4��8C proportion of HIV-positive women remain undiagnosed at delivery in the UK, which probably ICG-001 mw means that in recent years up to 2% of all HIV-exposed infants (born to diagnosed and undiagnosed women) have acquired HIV perinatally [1]. By 2010 over 98% of all diagnosed women received some form of ART prior

to delivery: the proportion of those who were taking zidovudine monotherapy dropped from around 20% in 2002–2003 to only about 2% since 2009. Meanwhile, the proportion of women delivering by elective Caesarean section (CS) declined from about two-thirds to around one-third, while vaginal deliveries increased from less than 15% of all deliveries to over 40%. Although planned vaginal delivery is now common for women who are on cART with undetectable viral load close to delivery, the increase in planned vaginal deliveries may have contributed to a rise in reported emergency CS, from around 20% to about 25% [6] Between 2005 and 2011 between 1100 and 1300 children were born each year in the UK to diagnosed HIV-positive women. Since virtually all diagnosed women in the last decade have taken ART to reduce the risk of MTCT, almost all of these children are uninfected. However, this means there were, in 2012, over 12 000 HIV-exposed uninfected children in the UK whose mothers conceived on cART, or started ART during pregnancy [6, 7].