Although perinatal transmission is the dominant route of HIV-1 infection in children, less than one-third of all babies acquire their mother's infection. In children who do become infected, the clinical course varies from indolent to rapidly fatal. An understanding of the factors contributing to these variations can lead to the development of management strategies that may diminish the spread and severity of this disease. Since most HIV-1 infected women in the U.S. are drug users, factors affecting a pregnant drug user's health should be examined as predictors of the clinical outcome of the child. This project will investigate the influence of maternal characteristics during pregnancy on the child's risk of infection and clinical course. The contribution of post-natal care patterns for these children to the child's clinical course will also be examined. The study will focus particularly on the impact of factors that can be modified such as methadone treatment and level of prenatal care for pregnant, HIV-infected women. A retrospective cohort of nearly 1100 New York State Medicaid-enrolled women who delivered 1330 babies in 1985-90 will be linked to their children's records for analysis. Maternal factors found in the Medicaid cohort to predict the child's risk of developing AIDS will also be tested as predictors of HIV transmission risk on a prospective cohort of 180 HIV-1 infected women and their offspring. This group has been followed at New York University/Bellevue Medical Center since 1986. The study aims are: 1. For children born to HIV-infected, NYS Medicaid-enrolled women, to determine the influence of maternal clinical characteristics and prenatal care as well as the child's perinatal and postnatal medical care on the child's risk of AIDS, clinical course, and life expectancy. Factors to be explored include the following: a) continuity of prenatal care; b) prenatal methadone treatment and psychiatric care; c) history of maternal untreated drug abuse; d) maternal stage of disease and clinical complications; e) type of delivery; f) child's pattern of ambulatory care; g) mother's and child's anti-retroviral and prophylactic drug treatment; and h) child's placement in foster care. 2. For children born to HIV-infected women in the prospective NYU/Bellevue cohort, to examine how predictors from aim #1 and measures such as maternal immune status during pregnancy in the prospective cohort affect the child's risk of becoming HIV-infected and, for the HIV-infected child, modify rate of disease progression to symptomatic disease and to death. This study is designed to identify health care delivery and clinical factors that may be modified to reduce the risk of infection and rate of disease progression in the child of an HIV-infected woman. This information is of central importance for planning services and delivering health care for this growing population.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
5R01DA007904-02
Application #
3214488
Study Section
Sociobehavioral Subcommittee (DAAR)
Project Start
1992-09-29
Project End
1995-09-28
Budget Start
1993-09-29
Budget End
1994-08-31
Support Year
2
Fiscal Year
1993
Total Cost
Indirect Cost
Name
Thomas Jefferson University
Department
Type
Schools of Medicine
DUNS #
061197161
City
Philadelphia
State
PA
Country
United States
Zip Code
19107
Cocroft, James R; Hauck, Walter W; Cosler, Leon et al. (2002) The effect of ethnicity and maternal birthplace on small-for-gestational-age deliveries to HIV-infected women. J Urban Health 79:147-60
Laine, C; Newschaffer, C J; Zhang, D et al. (2000) Adherence to antiretroviral therapy by pregnant women infected with human immunodeficiency virus: a pharmacy claims-based analysis. Obstet Gynecol 95:167-73
Newschaffer, C J; Cocroft, J; Anderson, C E et al. (2000) Prenatal zidovudine use and congenital anomalies in a medicaid population. J Acquir Immune Defic Syndr 24:249-56
Turner, B J; Newschaffer, C J; Zhang, D et al. (2000) Antiretroviral use and pharmacy-based measurement of adherence in postpartum HIV-infected women. Med Care 38:911-25
Newschaffer, C J; Zhang, D; Hauck, W W et al. (1999) Effect of enhanced prenatal and HIV-focused services for pregnant women who are infected by human immunodeficiency virus on emergency department use. Med Care 37:1308-19
Turner, B J; Newschaffer, C J; Zhang, D et al. (1999) Translating clinical trial results into practice: the effect of an AIDS clinical trial on prescribed antiretroviral therapy for HIV-infected pregnant women. Ann Intern Med 130:979-86
Newschaffer, C J; Cocroft, J; Hauck, W W et al. (1998) Improved birth outcomes associated with enhanced Medicaid prenatal care in drug-using women infected with the human immunodeficiency virus. Obstet Gynecol 91:885-91
Turner, B J; Hauck, W W; Fanning, T R et al. (1997) Cigarette smoking and maternal-child HIV transmission. J Acquir Immune Defic Syndr Hum Retrovirol 14:327-37
Silverman, N S; Rohner, D M; Turner, B J (1997) Attitudes toward health-care, HIV infection, and perinatal transmission interventions in a cohort of inner-city, pregnant women. Am J Perinatol 14:341-6
Krasinski, K; Turner, B J; Hauck, W W et al. (1997) HIV-1 infection in a population-based twin sample. Pediatr AIDS HIV Infect 8:114-9

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