Effect of Hard-Drug Use on CD4 Cell Percentage, HIV RNA Level and Progression to AIDS-Defining Events in HIV Positive Women

In vitro and animal studies suggest that cocaine and heroin increase HIV replication and suppress immune function, whereas epidemiologic studies are inconclusive regarding their effect on HIV disease progression.

The authors of the present study prospectively examined the association between illicit-drug use and 4 outcome measures:

·    CD4 cell percentage

·    HIV RNA level

·    Survival to class C diagnosis of HIV infection and

·    Death

Women in a national cohort enrolled between 1989 and 1995 were followed for 5 years and repeatedly interviewed about illicit ("hard")-drug use.

Up to 3 periodic urine screens validated self-reported use.

Outcomes were compared between hard-drug users (women using cocaine, heroin, methadone, or injecting drugs) and nonusers, adjusting for age, antiretroviral therapy, number of pregnancies, smoking, and baseline CD4 cell percentage.

Of 1148 women, 40% reported baseline hard-drug use during pregnancy.

In multivariate analyses, hard-drug use was not associated with change in CD4 cell percentage (P = 0.84), HIV RNA level (P = 0.48), or all-cause mortality (relative hazard = 1.10; 95% confidence interval, 0.61-1.98).

Hard-drug users did, however, exhibit a higher risk of developing class C [AIDS-defining] diagnoses (relative hazard = 1.65; 95% confidence interval, 1.00-2.72), especially herpes, pulmonary tuberculosis, and recurrent pneumonia.

The authors conclude, “Hard-drug-using women may have a higher risk for nonfatal opportunistic infections.”

From the New York City Department of Health and Mental Hygiene, New York, NY; Centers for Disease Control and Prevention, Division of Adult Community Health, Atlanta, GA; Clinical Trials and Surveys Corporation, Baltimore, MD; Columbia University College of Physicians and Surgeons, New York, NY; National Institute of Child Health and Human Development, Bethesda, MD; Baylor College of Medicine, Houston, TX; University of Massachusetts, Worcester, MA; University of Puerto Rico, San Juan, PR; State University of New York at Brooklyn, Brooklyn, NY; and University of Illinois at Chicago, Chicago, IL.

10/20/04

Reference
L E Thorpe and others. Effect of Hard-Drug Use on CD4 Cell Percentage, HIV RNA Level, and Progression to AIDS-Defining Class C Events Among HIV-Infected Women. Journal of Acquired Immune Deficiency Syndromes 37(3): 1423-1430. November 1, 2004.