HIV in Pregnancy. Final Programme. Joint RCOG/BHIVA Multidisciplinary Conference. Friday 20 January 2012

Transcription

1 Final Programme Joint RCOG/BHIVA Multidisciplinary Conference HIV in Pregnancy Friday 20 January 2012 Royal College of Obstetricians and Gynaecologists London Sponsored by

2 INTRODUCTION Dear Colleague We are delighted to welcome you on behalf of the Royal College of Obstetricians and Gynaecologists and the British HIV Association to this conference on HIV in pregnancy, bringing together obstetricians, HIV physicians, midwives, epidemiologists and peer supporters to review the key management issues in this specialist area. High rates of new HIV infections, coupled with increased longevity from improved therapy, mean that the prevalence of HIV in women is increasing. In % of new HIV diagnoses were made in women, and approximately one-third of those living with HIV in the UK are women. As treatments for HIV improve, leading to better health, increased life expectancy and reductions in the risk of both vertical and horizontal transmission, so the number of women living with HIV who are choosing to become pregnant is increasing. Management of HIV in pregnancy, ensuring the best long-term outcomes for both the mother and baby, presents a variety of challenges to those providing maternity care. Major advances in therapy have been made in the last two decades, resulting in a dramatic reduction in the risk of vertical transmission of HIV. However, opinion about the optimum obstetric management is still often based on data from the pre-haart era. Key issues include premature delivery, the management of premature rupture of membranes, emergency caesarean section, infant feeding and patients with HIV and hepatitis co-infection, all of which will be discussed within this conference. The programme will be delivered by a range of practising clinicians HIV physicians, obstetricians and specialist midwives, all of whom have significant hands-on experience in the management of HIV in pregnancy. Many of the speakers sit on the British HIV Association (BHIVA) writing committee for the 2012 national guidelines for the management of HIV in pregnancy. Lectures reviewing the evidence for recommendations, clinical cases and panel discussions with delegates will allow a review of the current evidence and a consideration of how best to put this into real-world practice. We are also fortunate in having several international speakers to help put UK practice into the wider global context. We would like to thank all our speakers and panel discussants for giving of their time to speak and share their expertise, and we extend our thanks to our sponsors whose generosity has allowed us to deliver the programme without cost to delegates. We very much hope you will enjoy the conference and find it relevant to both your educational and practical needs. Miss Ranee Thakar MD MRCOG Honorary Director of Conferences, RCOG Professor Jane Anderson, Chair, BHIVA CONFERENCE STEERING COMMITTEE Professor Jane Anderson (Chair) Dr David Asboe Professor Peter Brocklehurst Dr Annemiek de Ruiter Mr Ed Dorman Dr Yvonne Gilleece Miss Kate Harding Miss Naomi Low-Beer Ms Alison Perry Professor James Walker Homerton University Hospital, London Chelsea and Westminster Hospital, London University College London Hospital St Thomas Hospital, London Homerton University Hospital, London Royal Sussex County Hospital, Brighton Guy s and St Thomas NHS Foundation Trust, London Imperial College London St James s University Hospital, Leeds University of Leeds 6 CPD Credits Unique reference number:

3 CONFERENCE INFORMATION Conference venue Royal College of Obstetricians and Gynaecologists Registration 27 Sussex Place Regent s Park London NW1 4RG Telephone: Fax: Registration includes access to the scientific sessions, exhibition and refreshments as outlined in the conference programme. Delegate badges Badges must be worn at all times to gain access to the lecture theatre and catering areas. Continuing Professional Development (CPD) Medical staff in career grade posts who are enrolled with one of the Royal Medical Colleges for Continuing Professional Development will be entitled to receive CPD credits at the rate of one per conference hour. Please be advised that the attendance list for the conference will be kept on file for reference by the appropriate Royal Colleges. This event has been allocated 6 CPD credits and, for those who are registered for CPD accreditation with the Royal College of Physicians, the unique reference code is Travel Train: Underground: Parking: Marylebone Station 10 minutes walk Baker Street Station 10 minutes walk Regent s Park Outer Circle (pay and display) NCP on corner of Park Road and Rossmore Road, telephone: for further information. Accommodation Please visit: for local accommodation and delegate rate information. 3

4 PROGRAMME Registration and coffee Introduction Professor Jane Anderson, Chair, British HIV Association (BHIVA) Professor James Walker, Senior Vice-president, Royal College of Obstetricians and Gynaecologists (RCOG) Session One Chair: Professor Peter Brocklehurst, University College London Epidemiology of HIV among pregnant women in the UK and Ireland Dr Pat Tookey, Institute of Child Health, London Antiretroviral therapy in pregnancy What, why and when? Dr Annemiek de Ruiter, St Thomas Hospital, London Vaginal delivery and viral load At what viral load (VL) is spontaneous vaginal delivery (SVD) safe? Should women with an undetectable VL be treated as if they were HIV-negative? Miss Kate Harding, St Thomas Hospital, London Panel discussion Morning coffee Session Two Chair: Professor James Walker, University of Leeds Does antiretroviral therapy cause pre-term delivery (PTD)? Dr Claire Thorne, MRC Centre of Epidemiology for Child Health, London Screening and testing for trisomy 21 How to manage an HIV-positive woman requiring invasive prenatal tests and how to interpret results Miss Sam Pretlove, Birmingham Women s Hospital Panel discussion Session Three Chair: Professor Jane Anderson, Homerton University Hospital, London Peer support and the African experience Dr Mitch Besser, mothers2mothers, Cape Town, South Africa Peer support for pregnant women with HIV in the UK Ms Angelina Namiba, HIV i-base 4

5 PROGRAMME Lunch Session Four Chair: Mr Ed Dorman, Homerton University Hospital, London Long-term effects of in utero and neonatal antiretroviral drug exposure on exposed but uninfected infants Dr Steve Welch, Birmingham Heartlands Hospital HIV and breastfeeding: WHO and UK guidelines Dr Graham Taylor, Imperial College London Panel discussion to include Ms Alison Perry, St James s University Hospital, Leeds Session Five Chair: Professor Catherine Nelson-Piercy, Guy s and St Thomas NHS Foundation Trust, London Co-infection with hepatitis B or C Mother-to-child transmission (MTCT), choice of ART and mode of delivery Dr Ed Wilkins, North Manchester General Hospital Management of term and pre-term rupture of membranes (ROM) in HIV Dr Yvonne Gilleece, Royal Sussex County Hospital, Brighton Dr Kees Boer, Consultant Obstetrician, Academic Medical Center, Amsterdam, The Netherlands Panel discussion 1630 Summary and Close Professor Jane Anderson, Chair, British HIV Association (BHIVA) Professor James Walker, Senior Vice-president, Royal College of Obstetricians and Gynaecologists (RCOG) 5

6 BIOGRAPHIES Jane Anderson (Homerton University Hospital NHS Foundation Trust and Barts and the London School of Medicine and Dentistry) Working in East London, Professor Anderson s clinical practice and research interest focus on HIV in ethnic minority and migrant populations in the UK, with a special interest in the care of women with HIV. She has been elected Chair of the British HIV Association ( ) and is currently a member of the BHIVA Guidelines and Conference subcommittees. Mitchell Besser is an OBGYN whose career has been dedicated to the public health needs of women. He has been involved in HIV/PMTCT care since In 2001, he founded mothers2mothers, providing education and psychosocial support to pregnant women and new mothers living with HIV. Today, mothers2mothers reaches 20% of HIV-positive pregnant women in the world. Kees Boer worked until 2011 as obstetrician and associate professor in the Academic Medical Center, Amsterdam. He has treated HIV-infected pregnant women since He has published on HIV but also on pre-eclampsia, prenatal diagnosis and permanent effects of drugs on the offspring. Peter Brocklehurst is Director of the Institute for Women s Health at University College London, and Co-Director of the Policy Research Unit in Maternal Health and Care at the NPEU in Oxford, where he remains Professor of Perinatal Epidemiology. Peter currently leads a large programme of clinical trials in perinatal care and, in relation to HIV infection, he is co-author of three Cochrane reviews and has published in the area of condom availability and use in Kenya and post partum morbidity in HIV-infected women in Uganda. Annemiek de Ruiter is a Consultant Physician in HIV/GUM at St Thomas Hospital, London and has managed HIV-positive patients for over 20 years, specialising in the management of pregnant women with HIV. Dr de Ruiter has published extensively, formed local and national networks, collaborated widely, advised at a national level, lectured nationally and internationally and led the development of the BHIVA 2008 and 2012 pregnancy guidelines and the 2010 infant feeding guidelines. Edgar Dorman is an obstetrician at Homerton University Hospital in East London. Ed has a special interest in high-risk pregnancy and is the lead obstetrician for HIV. Prior to his current position, he worked for several years in East Africa where he carried out research on malaria and HIV in pregnancy. Yvonne Gilleece is a Consultant in HIV & Genitourinary Medicine at Brighton & Sussex University Hospitals NHS Trust and an Honorary Senior Lecturer at Sussex University. Dr Gilleece is the Lead for HIV in Pregnancy and Hepatitis B as well as a clinical supervisor for a PhD on HIV and Bone. She is a member of BASHH HIV SIG and has been an author on the BHIVA guidelines for Hepatitis and for HIV-2. Kate Harding has been a Consultant Obstetrician at Guy s and St Thomas Hospital since Kate is Lead Obstetrician for the Antenatal HIV service managing over 60 pregnant women annually. She has presented on HIV in pregnancy at numerous venues including Primary care 2010, British Maternal Fetal Medicine Conference, Royal Society of Medicine and Midwifery conferences. She is one of the two Obstetricians on the BHIVA HIV in Pregnancy 2011 writing committee and has co-written a recent article on the international perspective of managing HIV in Pregnancy. Her other roles include RCOG guidelines committee , International Society of Obstetric Medicine conference committee 2012 and Preceptor for the Advanced Antenatal care ATSM. Angelina Namiba has over 13 years experience of working in the HIV sector. As a woman living with HIV, Angelina is passionate about advocating for the sexual health and reproductive rights of women living with HIV. From she led on the planning, development and delivery of the pilot project From Pregnancy to Baby and Beyond with Positively UK. This developed a sustainable model of education, information, emotional and practical support for women living with HIV through ante- to post-natal care. She is currently training as a Treatment Advocate for HIV i-base. 6

7 BIOGRAPHIES Catherine Nelson-Piercy is a Consultant Obstetric Physician at Guy s and St Thomas Hospitals Trust and Queen Charlotte s and Chelsea Hospital in London. She specialises in the care of women with medical problems in pregnancy. Professor Nelson-Piercy runs special joint clinics for women with renal disease, cardiac and rheumatic disorders in pregnancy. She has been involved in the development of several evidence-based National Guidelines notably for Contraception in Women with Heart Disease, BTS/ SIGN Asthma in Pregnancy and RCOG Green Top guideline on Reducing the risk of thromboembolism during pregnancy, birth & the puerperium. Professor Nelson-Piercy is the President of the International Society of Obstetric Medicine (ISOM). Alison Perry has worked within the National Health Service since 1981; firstly completing her General Nurse Training and then Midwifery. She has responsibility for all the screening programmes related to pregnancy but her special interest remains with HIV and is responsible for around 60 women per year with HIV in pregnancy. Sam Pretlove completed her subspecialty training in Maternal and Fetal medicine at Birmingham Women s Hospital in 2010 before taking up her consultant post there. Alongside the HIV physicians, specialist midwives and paediatricians she manages the HIV work at BWH. The fetal medicine component of her job gives Dr Pretlove particular insight into the issues surrounding screening and prenatal diagnosis in HIV-positive women. Graham P Taylor is Reader in Communicable Diseases, Imperial College London and Honorary Consultant and Lead Clinician, National Centre for Human Retrovirology, St Mary s Hospital, London. Dr Taylor was Chief Medical Officer (Medicine) for the Solomon Islands before joining St. Mary s Hospital Medical School in His main interests lie in the management of HIV infection during pregnancy, particularly the safety, efficacy and pharmacokinetics of antiretroviral therapy. He has been a member of the BHIVA Guidelines Writing Committee on the Management of HIV infection in Pregnancy since the first guidelines (1998). Claire Thorne is a Wellcome Trust Research Career Development Fellow at University College London s Institute of Child Health, based in the Centre of Paediatric Epidemiology and Biostatistics. Dr Thorne is an infectious diseases epidemiologist with a specific focus on HIV in pregnant and childbearing women and mother-to-child transmission. Claire has led the scientific coordination of the European Collaborative Study (ECS), which involves a network of sites from 10 countries and more than 10,000 mother-child pairs, since January Her research interests are the complex relationships between pregnancy, HIV disease progression and antiretroviral therapy, mother-to-child transmission of HIV and its prevention, adverse effects of antiretroviral drugs in pregnancy and childhood, the HIV epidemic in Eastern Europe and Central Asia and HIV co-infections in pregnancy and childhood. Pat Tookey Dr Tookey is a non-clinical epidemiologist with a long-standing research interest in screening and infections affecting pregnant women and their children. She is responsible for the National Study of HIV in Pregnancy and Childhood (NSHPC) and is a co-investigator on CHIPS, the collaborative follow-up study of HIV infected children. James Walker is Professor, University Department of Obstetrics and Gynaecology, St James s University Hospital Trust, Leeds, and Senior Vice President, RCOG. He has a special interest in high-risk obstetrics particularly pre-eclampsia. He is Clinical Governance Lead to the senior Trust management. He is also leader of the Perinatal Research Group, Leeds Institute of Molecular Medicine, Obstetric Advisor to the National Patient Safety Agency and Medical Director of Action on Pre-eclampsia. Steve Welch has been a consultant in paediatric HIV and infectious diseases at Heartlands Hospital, Birmingham since He has helped establish adolescent transition services regionally, is one of the authors of the 2009 PENTA HIV treatment guideline, and a member of CHIVA s guidelines group. Steve is a member of the PENTA Steering Committee, and is jointly in charge of PENTA s training activities. He has been elected Chair of the Children s HIV Association ( ). Ed Wilkins is Consultant in Infectious Diseases and Director of the HIV Research Unit at North Manchester General Hospital. Dr Wilkins trained in infectious diseases in London and Liverpool, tropical medicine in Africa, and medical microbiology with the Health Protection Agency, prior to taking up his current position in He has been involved with HIV patient care and research since 1984, with interests in antiretroviral toxicity, hepatitis co-infection and the investigation of treatment strategies, as well as being an active member of many executive and advisory national committees including BHIVA. 7

8 Joint RCOG/BHIVA Multidisciplinary Conference HIV in Pregnancy Friday 20 January 2012 Royal College of Obstetricians and Gynaecologists London Conference Organiser: Mediscript Ltd 1 Mountview Court 310 Friern Barnet Lane London N20 0LD Publication date: January 2012