Head growth and neurodevelopment of infants born to HIV-1-infected drug-using women

Objective: To describe neurodevelopment and head growth in HIV-1-infected a nd 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 regres sion models to estimate the effects of HIV-1 infection and in utero hard dr ug exposure on head circumference and Bayley Scales of Infant Development s tandard scores during the first 30 months. Results: Of the 1,094 infants in cluded in the analysis, 147 (13%) were HIV-1-positive and 383 (35%) were ex posed in utero to opiates or cocaine (drug-positive). Mean 4- month Bayley mental scores were lower in infants with only HIV-1 positivity (HIV-positiv e and drug-negative) (-8.2 points, p < 0.0001) or only drug exposure (HIV-n egative 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 exp osed (HIV-negative and drug-negative). However, by 24 months of age, there was no longer a decrement among HIV-negative and drug-positive infants, whe reas HIV-1 infection was still associated with a decrement relative to unin fected infants. Similar results were seen for Bayley motor scores and for h ead circumference Z scores. Conclusions: HIV-1 infection and in utero opiat e and cocaine exposure decrease birth head circumference and slow neurodeve lopment at 4 months. At 24 months of age, however, only HIV-1 infection is associated with decreased neurodevelopment and head circumference. There ma y be some postnatal recovery from the effects of in utero hard drug exposur e. Importantly, the detrimental effects of HIV-1 positivity and maternal ha rd drug use on neurodevelopment at 4 months are not additive, although they are additive for birth head circumference.