Association of maternal drug use during pregnancy with maternal HIV culture positivity and perinatal HIV transmission

Objective: To evaluate the relationship of drug use with maternal HIV culture positivity at delivery and perinatal HIV transmission. Design: Multicenter prospective cohort study. Setting: Obstetric and pediatric clinics in five cities in the United States. Participants: Five hundred and thirty HIV-infected pregnant women and their infants. Main outcome measures: Multivariate logistic regression was used to evaluate the association of 'hard drug' use (one or more of the following: cocaine, heroin/opiates, methadone, injecting drug use) assessed by self-report and urine toxicology with positive maternal HIV culture at delivery and perinatal HIV transmission. Results: Forty-two per cent of women used hard drugs during pregnancy. Increased probability of a positive maternal delivery HIV culture was significantly associated with prenatal hard drug use [odds ratio (OR), 3.08] and maternal cocaine use (OR, 2.98) among HIV-infected women with > 29% CD4+ lymphocytes. After adjusting for maternal culture positivity at delivery, CD4+ lymphocyte percentage and gestational age, significantly greater transmission risk was observed with hard drug use among women with membrane rupture > 4 h. Conclusions: On the basis of self-report and urine toxicology, overall maternal hard drug use and cocaine use in the WITS cohort were associated with maternal HIV culture positivity at delivery, and maternal hard drug use was associated with perinatal transmission.