Injecting drug use in pregnant HIV-infected women in Europe.
OBJECTIVE
to describe the characteristics of pregnant HIV-infected women with past or current injecting drug use (IDU) and their infants in a large European cohort.


METHODS
prospective study.


METHODS
analysis of data on HIV-infected pregnant women enrolling in the European Collaborative Study, 1985 to May 2005. Factors examined included injecting behaviour, HIV-related and socio-demographic characteristics and pregnancy outcomes.


RESULTS
of the 5566 women enrolled, 2342 (42%) reported ever using injecting drugs, including 862 current users. Most IDUs were white and nulliparous at enrollment. Current IDUs were younger than ex-IDUs (respective median ages, 26.7 and 28.1 years), less likely to be married or cohabiting (57% (319/559) versus 74% (601/809), p<0.001) and more likely to report an IDU sexual partner (63% (483/762) versus 42% (548/1307) p<0.001). Of the current IDUs, 768 (89%) used illicit drugs throughout their pregnancy, with 567 having an infant with drug withdrawal symptoms. Overall, 42% (399/944) IDUs had a CD4 count of >or=500 cells/mm3, with current IDUs slightly more at risk of severe immunosuppression than ex-IDUs (17% versus 12%, p=0.058). Of the 2515 mother-child pairs, 1716 (68%) received no antenatal antiretroviral prophylaxis, 503 (20%) monotherapy or dual therapy and 296 (12%) HAART. The MTCT rate among women receiving any ART was 4.06% (95% CI 2.62-5.98) and 0.93% (95% CI 0.11-3.34) among those on HAART. In multivariable analysis, elective caesarean section was associated with an 82% reduced MTCT risk versus vaginal delivery (AOR 0.18, p<0.001) and maternal HAART with a 77% reduced risk versus no antenatal ART (AOR 0.23, p<0.001).


CONCLUSIONS
among the HIV-infected pregnant women in this cohort, characteristics of current and ex-IDUs differed considerably. However, MTCT risk did not vary according to IDU, and risk factors for transmission were as described for women with no history of IDU in this cohort and elsewhere.
Thorne
Claire
C
Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK. c.thorne@ich.ucl.ac.uk
Newell
Marie-Louise
ML
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D004359:Drug Therapy, Combination; D005060:Europe / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000209:etiology / Q000276:immunology / Q000635:transmission; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000706:statistics & numerical data; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000453:epidemiology*