Crack-cocaine use accelerates HIV disease progression in a cohort of HIV-positive drug users

Marianna K. Baum, Carlin Rafie, Shenghan Lai, Sabrina Sales, John Page, Adriana Campa

Research output: Contribution to journalArticle

147 Citations (Scopus)

Abstract

BACKGROUND: HIV infection is prevalent among substance abusers. The effects of specific illicit drugs on HIV disease progression have not been established. We evaluated the relationship between substances of abuse and HIV disease progression in a cohort of HIV-1-positive active drug users. METHODS: A prospective, 30-month, longitudinal study was conducted on 222 HIV-1 seropositive drug users in Miami, FL. History of illicit drug, alcohol, and medication use, CD4 cell count, and viral load were performed every 6 months. RESULTS: Crack-cocaine users were 2.14 times [95% confidence interval (CI): 1.08 to 4.25, P = 0.029] more likely to present a decline of CD4 to ≤200 cells/mL, independent of antiretroviral use. Viral load over 30 months was significantly higher in crack users (β = 0.315, P = 0.037) independent of highly active antiretroviral therapy (HAART) over time. The only multidrug combination that significantly increased the risk of disease progression was crack cocaine with marijuana (hazard ratio = 2.42; 95% CI: 1.042 to 5.617, P = 0.04). Of those on HAART, a significantly lower proportion of crack-cocaine users versus nonusers had controlled viral load (P < 0.001), suggesting lower medication adherence, whereas crack-cocaine users not on HAART showed a greater risk for HIV disease progression than nonusers (hazard ratio = 3.946; 95% CI: 1.049 to 14.85, P = 0.042). CONCLUSIONS: Crack-cocaine use facilitates HIV disease progression by reducing adherence in those on HAART and by accelerating disease progression independently of HAART.

Original languageEnglish
Pages (from-to)93-99
Number of pages7
JournalJournal of Acquired Immune Deficiency Syndromes
Volume50
Issue number1
DOIs
StatePublished - Jan 1 2009

Fingerprint

Crack Cocaine
Drug Users
Highly Active Antiretroviral Therapy
Disease Progression
HIV
Viral Load
Street Drugs
Confidence Intervals
HIV-1
Medication Adherence
Cannabis
CD4 Lymphocyte Count
HIV Infections
Substance-Related Disorders
Longitudinal Studies
Alcohols

Keywords

  • CD4+ cell count
  • Crack-cocaine
  • HIV
  • HIV disease progression
  • HIV viral load
  • Marijuana

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

Cite this

Crack-cocaine use accelerates HIV disease progression in a cohort of HIV-positive drug users. / Baum, Marianna K.; Rafie, Carlin; Lai, Shenghan; Sales, Sabrina; Page, John; Campa, Adriana.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 50, No. 1, 01.01.2009, p. 93-99.

Research output: Contribution to journalArticle

Baum, Marianna K. ; Rafie, Carlin ; Lai, Shenghan ; Sales, Sabrina ; Page, John ; Campa, Adriana. / Crack-cocaine use accelerates HIV disease progression in a cohort of HIV-positive drug users. In: Journal of Acquired Immune Deficiency Syndromes. 2009 ; Vol. 50, No. 1. pp. 93-99.
@article{7fd21c14bcf74728b37cd6b422bbc95a,
title = "Crack-cocaine use accelerates HIV disease progression in a cohort of HIV-positive drug users",
abstract = "BACKGROUND: HIV infection is prevalent among substance abusers. The effects of specific illicit drugs on HIV disease progression have not been established. We evaluated the relationship between substances of abuse and HIV disease progression in a cohort of HIV-1-positive active drug users. METHODS: A prospective, 30-month, longitudinal study was conducted on 222 HIV-1 seropositive drug users in Miami, FL. History of illicit drug, alcohol, and medication use, CD4 cell count, and viral load were performed every 6 months. RESULTS: Crack-cocaine users were 2.14 times [95{\%} confidence interval (CI): 1.08 to 4.25, P = 0.029] more likely to present a decline of CD4 to ≤200 cells/mL, independent of antiretroviral use. Viral load over 30 months was significantly higher in crack users (β = 0.315, P = 0.037) independent of highly active antiretroviral therapy (HAART) over time. The only multidrug combination that significantly increased the risk of disease progression was crack cocaine with marijuana (hazard ratio = 2.42; 95{\%} CI: 1.042 to 5.617, P = 0.04). Of those on HAART, a significantly lower proportion of crack-cocaine users versus nonusers had controlled viral load (P < 0.001), suggesting lower medication adherence, whereas crack-cocaine users not on HAART showed a greater risk for HIV disease progression than nonusers (hazard ratio = 3.946; 95{\%} CI: 1.049 to 14.85, P = 0.042). CONCLUSIONS: Crack-cocaine use facilitates HIV disease progression by reducing adherence in those on HAART and by accelerating disease progression independently of HAART.",
keywords = "CD4+ cell count, Crack-cocaine, HIV, HIV disease progression, HIV viral load, Marijuana",
author = "Baum, {Marianna K.} and Carlin Rafie and Shenghan Lai and Sabrina Sales and John Page and Adriana Campa",
year = "2009",
month = "1",
day = "1",
doi = "10.1097/QAI.0b013e3181900129",
language = "English",
volume = "50",
pages = "93--99",
journal = "Journal of acquired immune deficiency syndromes (1999)",
issn = "1525-4135",
publisher = "Lippincott Williams and Wilkins Ltd.",
number = "1",

}

TY - JOUR

T1 - Crack-cocaine use accelerates HIV disease progression in a cohort of HIV-positive drug users

AU - Baum, Marianna K.

AU - Rafie, Carlin

AU - Lai, Shenghan

AU - Sales, Sabrina

AU - Page, John

AU - Campa, Adriana

PY - 2009/1/1

Y1 - 2009/1/1

N2 - BACKGROUND: HIV infection is prevalent among substance abusers. The effects of specific illicit drugs on HIV disease progression have not been established. We evaluated the relationship between substances of abuse and HIV disease progression in a cohort of HIV-1-positive active drug users. METHODS: A prospective, 30-month, longitudinal study was conducted on 222 HIV-1 seropositive drug users in Miami, FL. History of illicit drug, alcohol, and medication use, CD4 cell count, and viral load were performed every 6 months. RESULTS: Crack-cocaine users were 2.14 times [95% confidence interval (CI): 1.08 to 4.25, P = 0.029] more likely to present a decline of CD4 to ≤200 cells/mL, independent of antiretroviral use. Viral load over 30 months was significantly higher in crack users (β = 0.315, P = 0.037) independent of highly active antiretroviral therapy (HAART) over time. The only multidrug combination that significantly increased the risk of disease progression was crack cocaine with marijuana (hazard ratio = 2.42; 95% CI: 1.042 to 5.617, P = 0.04). Of those on HAART, a significantly lower proportion of crack-cocaine users versus nonusers had controlled viral load (P < 0.001), suggesting lower medication adherence, whereas crack-cocaine users not on HAART showed a greater risk for HIV disease progression than nonusers (hazard ratio = 3.946; 95% CI: 1.049 to 14.85, P = 0.042). CONCLUSIONS: Crack-cocaine use facilitates HIV disease progression by reducing adherence in those on HAART and by accelerating disease progression independently of HAART.

AB - BACKGROUND: HIV infection is prevalent among substance abusers. The effects of specific illicit drugs on HIV disease progression have not been established. We evaluated the relationship between substances of abuse and HIV disease progression in a cohort of HIV-1-positive active drug users. METHODS: A prospective, 30-month, longitudinal study was conducted on 222 HIV-1 seropositive drug users in Miami, FL. History of illicit drug, alcohol, and medication use, CD4 cell count, and viral load were performed every 6 months. RESULTS: Crack-cocaine users were 2.14 times [95% confidence interval (CI): 1.08 to 4.25, P = 0.029] more likely to present a decline of CD4 to ≤200 cells/mL, independent of antiretroviral use. Viral load over 30 months was significantly higher in crack users (β = 0.315, P = 0.037) independent of highly active antiretroviral therapy (HAART) over time. The only multidrug combination that significantly increased the risk of disease progression was crack cocaine with marijuana (hazard ratio = 2.42; 95% CI: 1.042 to 5.617, P = 0.04). Of those on HAART, a significantly lower proportion of crack-cocaine users versus nonusers had controlled viral load (P < 0.001), suggesting lower medication adherence, whereas crack-cocaine users not on HAART showed a greater risk for HIV disease progression than nonusers (hazard ratio = 3.946; 95% CI: 1.049 to 14.85, P = 0.042). CONCLUSIONS: Crack-cocaine use facilitates HIV disease progression by reducing adherence in those on HAART and by accelerating disease progression independently of HAART.

KW - CD4+ cell count

KW - Crack-cocaine

KW - HIV

KW - HIV disease progression

KW - HIV viral load

KW - Marijuana

UR - http://www.scopus.com/inward/record.url?scp=64249165706&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=64249165706&partnerID=8YFLogxK

U2 - 10.1097/QAI.0b013e3181900129

DO - 10.1097/QAI.0b013e3181900129

M3 - Article

C2 - 19295339

AN - SCOPUS:64249165706

VL - 50

SP - 93

EP - 99

JO - Journal of acquired immune deficiency syndromes (1999)

JF - Journal of acquired immune deficiency syndromes (1999)

SN - 1525-4135

IS - 1

ER -