Marseille 2007
Marseille 2007
Abstract book
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Abstract #509  -  Effects of Crack Cocaine Use on Immune Suppression, Viral Load, and Mortality in a U.S. Multi-Site Cohort of HIV-Positive Women
Session:
  41.3: Drugs Alcohol and Potions (Parallel) on Tuesday @ 16.30-18.30 in 3 Chaired by Jeffrey Weiss, Biljana Ristic
Authors:
  Presenting Author:   Prof Judith Cook - University of Illinois at Chicago, United States
 
  Additional Authors:  Mr Dennis Grey, Ms Jane Burke-Miller,  
Aim:
This study explored the direct effects of crack cocaine use on immune suppression, viral load, and AIDS-related mortality. Hypothesis one proposed that women with more consistent and recent use of crack cocaine would have higher HIV RNA viral loads, negative CD4 cell count slopes, and greater likelihood of AIDS-related mortality. Hypothesis two proposed that these effects would be direct and not mediated by the influence of highly active antiretroviral therapy (HAART) use, HAART adherence, alcohol use, study site, or the women's demographic variables.
 
Method / Issue:
The Womens Interagency HIV Study (WIHS) is a multi-site study of women in 6 U.S. cities: Chicago, Los Angeles, San Francisco, Brooklyn, Bronx, and Washington, DC. HIV-positive study participants (N=1,691) were assessed biannually from April 1994 through September 2004. The women's longitudinal reports of crack cocaine use were categorized to allow use to vary over time, while capturing both persistence of use as well as active use at each study visit, coded as 1) never, 2) intermittent but not active at time of visit, 3) intermittent and active at study visit, and 4) chronic and persistent at every study visit. Plasma HIV-RNA was categorized as greater than versus less than 100,000 copies. CD4 slope was calculated from biannual CD4 counts. AIDS-related mortality was defined as death due to HIV-related opportunistic infections/malignancies or organ failure/nonspecific infections with CD4 less than 200. Outcomes were analyzed by time-varying stepwise random mixed-effects regression. Multivariate models controlled for study site, time, age, race/ethnicity, income, education, problem drinking (defined as >7 drinks per week according to guidelines for women from the National Institute on Alcohol Abuse and Alcoholism)/and or binge drinking (defined per guidelines as 4 or more drinks per episode), HAART use, and adherence.
 
Results / Comments:
At baseline, 15% reported using crack cocaine, 14% problem and/or binge drinking, and 6% both. In all multivariate analysis, chronic crack use was significantly associated with viral load >100,000 copies, negative CD4 cell count slope, and higher AIDS-related mortality. Intermittent but active use was associated with negative CD4 slope only. These effects were independent of HAART use, HAART adherence, and problem drinking. In separate analyses, HAART by crack and HAART by at-risk drinking interactions were tested. Here, HAART users who also used crack were more likely to have low CD4 and high viral load, while HAART users who were at-risk drinkers were not, indicating that crack use overrides the effectiveness of HAART while alcohol use does not.
 
Discussion:
Effects of chronic crack cocaine use are directly associated with HIV disease progression and mortality, independent of antiretroviral therapy, adherence, and alcohol use. Crack cocaine use may influence disease progression through health behaviors such as nutrition, psychological influences such as depression or anxiety, or through direct biological effects. Results suggest that failure to treat cocaine addiction among HAART users, even those who are adherent, runs the risk of substantially attenuating the effectiveness of this potent antiretroviral therapy.
 
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