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PEDIATRICS Vol. 113 No. 5 May 2004, pp. 1260-1266

Immune Parameters and Morbidity in Hard Drug and Human Immunodeficiency Virus-xposed but Uninfected Infants

Natalie Neu, MD*, Robert Leighty, PhD{ddagger}, Samuel Adeniyi-Jones, MD, PhD§, Clemente Diaz, MD||, Edward Handelsman, MD, Gary Kaufman, MD#, Mary E. Paul, MD**, Kenneth Rich, MD{ddagger}{ddagger}, Lynne Mofenson, MD§§, Jane Pitt, MD{dagger} and for the Women and Infants Transmission Study

* Columbia University, New York, New York
{ddagger} C-TASC, Baltimore, Maryland
§ National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
|| University of Puerto Rico, San Juan, Puerto Rico
State University of New York Downstate, New York, New York
# Boston Medical Center, Boston, Massachusetts
** Baylor College of Medicine, Houston, Texas
{ddagger}{ddagger} University of Illinois, Chicago, Illinois
§§ National Institute of Child Health and Human Development, Bethesda, Maryland

Objective. To examine the association of maternal hard drug use (injection drugs, cocaine, and opiates) on lymphocyte subsets and clinical morbidity in uninfected infants who are born to human immunodeficiency virus-infected mothers who were enrolled in the Women and Infants Transmission Study (1990–2000).

Methods. Maternal hard drug use was identified by self-report and/or urine toxicology. Infant evaluations occurred at birth and at 1, 2, 4, 6, 9, 12, 18, and 24 months of age.

Results. A total of 401 (28%) of the 1436 uninfected infants were born to drug-using mothers. Maternal CD4 lymphocyte percentage and RNA at delivery were not significantly different between drug users and nonusers. Infants who were born to drug-using mothers had lower mean gestational age (37.8 vs 38.5 weeks) and birth weight (2.9 vs 3.1 kg). Infants with intrauterine drug exposure had lower CD4 lymphocyte percentage over the first 4 months of life after adjusting for covariates and higher natural killer lymphocyte percentage. When the analysis was stratified by time period of entry, the incidence of clinical events was not different between infants who were born to drug users versus nonusers.

Conclusion. Maternal hard drug use is associated with immunologic changes in infants early in life, although these changes did not seem to be associated with increased risk of infections.

Key Words: HIV exposed infants • drug use • infant lymphocyte markers

Abbreviations: NK, natural killer • HIV, human immunodeficiency virus • WITS, Women and Infants Transmission Study • ART, antiretroviral therapy • HAART, highly active antiretroviral therapy • HSV, herpes simplex virus • TMP/SMX, trimethoprim-sulfamethoxazole

Received for publication Feb 7, 2003; Accepted Jun 13, 2003.




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