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Published on: January 12, 2016
Head growth and neurodevelopment of infants born to HIV-1-infected drug-using women
C Macmillan1, L S Magder, P Brouwers
1Department of Neurology, University of Illinois at Chicago 60612-7330, USA. cmacmillan@uic.edu
Insights
Human immunodeficiency virus (HIV-1) infection and in utero opiate/cocaine exposure impact infant neurodevelopment and head growth. While drug exposure effects may recover, HIV-1 infection shows lasting detrimental effects on development.
Area of Science:
- Pediatric Neurodevelopment
- Infectious Diseases
- Neonatal Toxicology
Background:
- Infants born to mothers with HIV-1 infection or substance use disorders face unique developmental challenges.
- Understanding the combined and independent effects of these exposures is crucial for early intervention.
Purpose of the Study:
- To assess neurodevelopment and head growth in infants with HIV-1 infection and/or in utero exposure to opiates and cocaine.
- To differentiate the long-term impacts of HIV-1 infection versus prenatal drug exposure on infant development.
Main Methods:
- Analysis of a multicenter cohort study involving HIV-1-infected women and their children.
- Repeated measures regression models used to evaluate head circumference and Bayley Scales of Infant Development scores up to 30 months.
- Comparison of four infant groups: HIV-1 positive/drug-exposed, HIV-1 positive/drug-unexposed, HIV-1 negative/drug-exposed, and HIV-1 negative/drug-unexposed.
Main Results:
- At 4 months, infants with HIV-1 infection or prenatal drug exposure showed lower Bayley mental scores compared to unexposed infants.
- By 24 months, the negative impact of drug exposure on neurodevelopment diminished, while HIV-1 infection remained associated with developmental deficits.
- Similar trends were observed for motor scores and head circumference Z scores, with HIV-1 infection showing persistent effects.
Conclusions:
- Both HIV-1 infection and in utero opiate/cocaine exposure negatively affect birth head circumference and early neurodevelopment.
- Long-term neurodevelopmental and head growth deficits at 24 months are primarily associated with HIV-1 infection.
- Postnatal recovery from prenatal hard drug exposure effects is possible, and their combined impact with HIV-1 is not additive at 4 months but is for birth head circumference.
Objective:
To describe neurodevelopment and head growth in HIV-1-infected and exposed uninfected infants with and without in utero exposure to opiates and cocaine.
Methods:
Using data from a multicenter cohort study of HIV-1-infected women and their children, the authors fit repeated measures regression models to estimate the effects of HIV-1 infection and in utero hard drug exposure on head circumference and Bayley Scales of Infant Development standard scores during the first 30 months.
Results:
Of the 1,094 infants included in the analysis, 147 (13%) were HIV-1-positive and 383 (35%) were exposed in utero to opiates or cocaine (drug-positive). Mean 4- month Bayley mental scores were lower in infants with only HIV-1 positivity (HIV-positive and drug-negative) (-8.2 points, p < 0.0001) or only drug exposure (HIV-negative and drug-positive) (-4.4 points, p = 0.0001) and tended to be lower in infants with both factors (HIV-positive and drug-positive) (-3.7 points, p = 0.0596), compared with those who were HIV-1-negative and not drug exposed (HIV-negative and drug-negative). However, by 24 months of age, there was no longer a decrement among HIV-negative and drug-positive infants, whereas HIV-1 infection was still associated with a decrement relative to uninfected infants. Similar results were seen for Bayley motor scores and for head circumference Z scores.
Conclusions:
HIV-1 infection and in utero opiate and cocaine exposure decrease birth head circumference and slow neurodevelopment at 4 months. At 24 months of age, however, only HIV-1 infection is associated with decreased neurodevelopment and head circumference. There may be some postnatal recovery from the effects of in utero hard drug exposure. Importantly, the detrimental effects of HIV-1 positivity and maternal hard drug use on neurodevelopment at 4 months are not additive, although they are additive for birth head circumference.
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