ORIGINAL RESEARCH Management of HIV and pregnancy in England's North Thames Region 1999: a survey of practice in 21 hospitals MG Brook, 1,2, * GP Taylor, 3 A Dale, 2,4 EGH Lyall 5 and D Tomlinson 2,6 1 Department of Genitourinary/HIV Medicine, Patrick Clements Clinic, Central Middlesex Hospital, Acton Lane, London NW107NS, 2 North Thames Regional GU/HIV Audit Group, London, 3 Academic Department of Genitourinary Medicine and Communicable Diseases, St Mary's Hospital, Imperial College School of Medicine, London, 4 Clinical Governance Support Unit, Camden and Islington Community Health Services NHS Trust, London, 5 Department of Paediatrics and 6 Department of Genitourinary/HIV Medicine, St Mary's Hospital, Imperial College SchoolofMedicine,London,UK Objectives To ascertain current practices in the diagnosis and management of HIV and pregnancy in the North Thames Region. Methods Postal survey using a self-completed questionnaire sent to the head of all of the Region's 34 units involved in the care of HIV. The survey asked questions on current policy around HIV and pregnancy in the HIV units and associated antenatal clinics and was linked to a case-note survey of pregnant, HIV-positive women in the last 2 years. Results Over 50% of the responding antenatal units recommended the HIV test by March 1999. Most HIV units were offering a range of antiretroviral regimens in pregnancy, although a minority (33%) did not offer triple therapy. Elective Caesarean section was the recommended mode of delivery for most women (90%) irrespective of drug therapy or viral load. Most infants were being tested for HIV infection by a combination of PCR, viral culture and antibody testing to 18 months of age. All the infants (19) followed to 6 months of age in the case-note survey were PCR negative. Reporting rates to the National Survey of HIV in Pregnancy were high (87%) but poor for the Drug Exposure Register (33%). Conclusions Management of HIV and pregnancy in the North Thames units showed a large amount of consistency with regard to testing policies and management. However, there were a few units that did not offer therapy appropriate for advanced disease despite the recommendations of national bodies and a few units still did not recommend HIV testing to all women. Key words: antiretroviral therapy, Caesarian section, HIV, pregnancy, screening Received:19November1999,accepted27March2000 Introduction Approximately 50% of all known HIV-infected individuals in the United Kingdom live in the North Thames region, which includes London north of the River Thames and the counties bordering North London [1]. Within the region are many of the UK's largest HIV units and an HIV-positive population that includes a signi®cant number of women. Since 1992 the Department of Health has recommended that an HIV test be offered to all women attending for antenatal care in areas of high prevalence and most of the hospitals in North Thames are covered by this directive. The Regional HIV Audit group has been in existence for 6 years and regularly performs region-wide surveys and audits of HIV care. In April 1998 the joint working party of the Royal Colleges of Paediatrics, Obstetrics and Midwifery suggested that the HIV test should be recommended to all women in high prevalence areas. Twelve months later we surveyed the North Thames antenatal units to audit current screening practice. Guidelines for the management of HIV *Correspondence author 143 Ó 2000 British HIV Association HIV Medicine (2000) 1, 143±147 Ó 2000 British HIV Association HIV Medicine (2000) 1, 143±147