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Antenatal HIV screening policies throughout the British Isles surveyed and results linked to data on HlV-infected pregnant women notified through the Royal College of Obstetricians and Gynaecologists. Units offering HIV testing to all pregnant women were compared with those offering it only to women considered to be at risk, and in both situations fewer than 50% of infected women were identified as HIV infected for the first time in antenatal clinics. Based on laboratory reports of HIV infection in women of childbearing age, paediatric reports of children born to HIV positive women and unlinked anonymous neonatal screening programmes there was evidence of under-recognition of HIV infection in pregnancy, particularly in England and Wales. [ABSTRACT FROM AUTHOR]

In order to review the clinical course, laboratory findings, and outcome of children with vertically acquired HIV infection and Pneumocystis carinii pneumonia, questionnaires were sent to paediatricians in the British Isles who had reported P carinii pneumonia and HIV infection through the British Paediatric Surveillance Unit (BPSU). Paediatric reports from the BPSU are linked to reports of pregnancies in HIV positive women and laboratory reports. P carinii pneumonia was the most frequently reported AIDS indicator disease at AIDS diagnosis, occurring in 22/56 (40%) children born in the British Isles; in a further two children P carinii pneumonia occurred after another AIDS indicator disease. The median age at P carinii pneumonia diagnosis was 4.1 (1.4-27.3) months and in 48% it occurred with other AIDS indicator diseases. Despite intensive treatment the three month survival was only 38%. The nine children surviving P carinii pneumonia subsequently developed further AIDS indicator diseases, in particular HIV encephalopathy and four have since died. P carinii pneumonia was present at AIDS diagnosis in 65% of children developing AIDS in the first year of life and caused 82% of infant deaths. Most children were not known to be at risk of HIV until they presented with P carinii pneumonia. Children with HIV infection develop P carinii pneumonia at an early age and have a poor outcome. Increased awareness of the condition is required to initiate early treatment. Prevention may be a compelling incentive for screening in pregnancy, but further study is required to quantify the risks and benefits of initiating early P carinii pneumonia prophylaxis as well as the impact this might have on life expectancy. [ABSTRACT FROM AUTHOR]

Assesses the extent of unrecognized human immunodeficiency virus (HIV) infection in the heterosexual community. The number of seropositives found in an unlinked anonymous testing program was compared with the number of reports of births to women known to be infected.