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, Bryan; Campa, Adriana

doi:10.1097/qai.0b013e3181900129

Cited by 223 publications

(199 citation statements)

References 32 publications

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“…One plausible explanation is that recent research showing reduced transmission risk among HIV-positive individuals on antiretroviral therapy (Cohen et al, 2011;Donnell et al, 2010;Grant et al, 2010) could affect risk perceptions and resulting behaviors. Although one of many possible explanations, this could be particularly important to examine in settings where substance use is high (see Kalichman et al, 2011), because substance use has been shown to negatively affect HIV treatment adherence and viral load counts (Arnsten et al, 2002;Baum et al, 2009Baum et al, , 2010Fairbairn et al, 2011;Hahn and Samet, 2010;King et al, 2009;Shacham et al, 2011;Toussi et al, 2009) as well as resistance to antiretroviral medications (Cachay et al, 2007;Colfax et al, 2007).…”

Section: Discussionmentioning

confidence: 99%

“…Likewise, crystal methamphetamine use among HIV-positive individuals has been found to be associated with decreased CD4 cell counts or nonsuppression of HIV viral load (Fairbairn et al, 2011;King et al, 2009;Toussi et al, 2009), neurode-generation or memory impairment (Scott et al, 2007), and resistance to antiretroviral medications (Cachay et al, 2007;Colfax et al, 2007). Cocaine or crack-cocaine use among HIV-positive individuals has been found to be associated with decreased CD4 cell counts or nonsuppression of HIV viral load (Arnsten et al, 2002;Baum et al, 2009;Rafi e et al, 2011), increases in hypertensive renal changes (Fine et al, 2007), and coronary stenosis (Lai et al, 2008).…”

Section: H IV Continues To Disproportionately Affect Men Who Have Sexmentioning

confidence: 99%

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Risk Behaviors Among HIV-Positive Gay and Bisexual Men at Party-Oriented Vacations

Fisher

Ramchand

Bana

et al. 2013

J. Stud. Alcohol Drugs

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ABSTRACT. Objective: This study examined substance use (intended and actual), unprotected sex, and HIV disclosure practices (disclosure and questioning) among HIV-positive men who have sex with men (MSM) at two party-oriented vacations, where substance use and sexual risk may be heightened. Method: A random sample of 489 MSM attending one of two party-oriented vacations participated in PartyIntents, a short-term longitudinal survey. Nearly half (47%) completed a follow-up assessment at the event or online for up to 2 weeks after the event. We examined rates of baseline intentions to use substances, actual substance use, and unprotected intercourse among HIV-positive men in attendance. Rates among HIV-negative men were estimated for comparison. Multiple logistic regression was used to assess the impact of illegal drug use and HIV status on unprotected anal intercourse (UAI). Results: HIV-positive attendees (17%) were signifi cantly more likely than HIV-negative attendees to use nitrite inhalants (or "poppers") (24.3% vs. 10.7%). HIVpositive attendees were also signifi cantly more likely to have insertive UAI (64.3% vs. 34.1%) and receptive UAI (68.8% vs. 22.2%). Multivariate models showed associations between HIV status and illegal drug use with UAI (for HIV status, odds ratio [OR] = 4.5, p = .001; for any illegal drug use, OR = 16.4, p < .001). There was no evidence that the infl uence of drug use moderated risk by HIV status. Rates of HIV disclosure and questioning did not differ by HIV status. Conclusions: HIV-positive men attending these events engaged in higher rates of illegal drug use and sexual risk than HIV-negative men. Prevention campaigns targeting MSM at high-risk events should include messages geared toward HIVpositive men. (J. Stud. Alcohol Drugs, 74, 158-167, 2013)

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Section: Discussionmentioning

confidence: 99%

Section: H IV Continues To Disproportionately Affect Men Who Have Sexmentioning

confidence: 99%

Risk Behaviors Among HIV-Positive Gay and Bisexual Men at Party-Oriented Vacations

Fisher

Ramchand

Bana

et al. 2013

J. Stud. Alcohol Drugs

View full text Add to dashboard Cite

show abstract

“…In a prior study, Baum and colleagues reported that, independent of adherence to highly active antiretroviral therapy (HAART), HIV-infected crack cocaine users were more likely to experience a decline in CD4 cell count and an increase in viral load over 30 months. 31 Similarly, Cook and colleagues found in the Women's Interagency HIV Study cohort of HIVinfected women that crack cocaine-using women showed greater CD4 cell loss and higher HIV-1 RNA levels, even after controlling for use of HAART, other illicit substances used, depression, and hepatitis C virus coinfection. 32 These consistent findings of an association between cocaine use and decline in CD4 cell counts independent of HAART use led to subsequent studies that identified several alternative mechanisms for cocaine-related disease progression, including reduced thymic endocrine function 33 and enhanced permissiveness of quiescent T cells.…”

Section: Discussionmentioning

confidence: 99%

Levamisole-Contaminated Cocaine Use in HIV-Infected and Uninfected Unstably Housed Women

Riley

Kral

Cohen

et al. 2016

Journal of Women's Health

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A growing number of case reports cite serious health complications linked to the cocaine adulterant, levamisole and women are disproportionately affected; however, the clinical effects are not well established. Between April and October of 2010, we conducted a cross-sectional study among 222 homeless and unstably housed women (116 human immunodeficiency virus [HIV]-infected and 106 HIV-uninfected). Immune markers and behavioral factors were compared in separate models by cocaine and levamisole exposure. Overall, 63% of participants were toxicology positive for cocaine/benzoylecgonine, 85% of whom also tested positive for levamisole. Differences in immune markers did not reach levels of significance among HIV-uninfected persons. Compared to HIV-infected persons who were negative for both cocaine and levamisole, the adjusted odds of low white blood cell count were significantly higher among HIV-infected persons positive for both ( p = 0.03), but not for those positive for cocaine only. Neutrophil count and HIV viral load did not differ by cocaine and levamisole status among HIV-infected persons. In a separate model, the adjusted odds of testing positive for levamisole were higher among African American women compared to Caucasian and Asian women ( p = 0.02). In the context of high levamisole prevalence, results suggest that decreased immune function as a result of levamisole exposure occurs mainly in individuals who are already immune compromised (e.g., HIV-positive), and race/ethnicity appears to be an important factor in understanding levamisole exposure among cocaine-using women. While larger and geographically diverse studies are needed to elucidate these initial findings, results suggest that levamisole may be one mechanism of immune dysfunction in HIV-infected cocaine-using women.

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“…Other studies indicate that the progression of HIV disease does not differ between IDUs and non-IDUs (Chaisson et al 1995;Pezzotti et al 1999) or that it is faster in intravenous crack/cocaine than opioid (i.e. heroin) abuse (Baum et al 2009). Historically, responses to treatment for HIV were substantially lower in IDUs.…”

Section: Human Immunodeficiency Virus (Hiv)mentioning

confidence: 97%

Immunosuppressive Effects of Opioids—Clinical Relevance

Brack

Rittner

Stein

2011

J Neuroimmune Pharmacol

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Opioid-induced immunosuppression has been demonstrated in cell culture experiments and in animal models. This is in striking contrast to the paucity of confirmatory studies in humans. This review describes the basic pharmacokinetics and -dynamics of opioid use in patients. It summarizes the major findings on opioid use and infectious complications in intensive care unit (ICU) patients, in patients with acute or chronic non-malignant pain, and in intravenous drug users (IDU). The limitations of studies in each area are discussed. For example, ethical concerns may complicate randomized placebo-controlled trials (RCT) in acute postoperative pain and for a large part of ICU patients. Importantly, most studies in patients with chronic (non-malignant) pain only inadequately report infectious complications in relation to opioid use since their incidence is usually not considered to be drug related. Infectious complications in IDUs are very frequent but cannot easily be distinguished from risk behavior or risk environment. In summary, convincing clinical evidence is lacking that opioids per se increase the rate of infectious complications in most patient categories. From a clinical standpoint, important unresolved issues are i) selection of relevant animal models, ii) opioid selection and discontinuation, and iii) the role of coexisting diseases and concomitant other medications.

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Crack-Cocaine Use Accelerates HIV Disease Progression in a Cohort of HIV-Positive Drug Users

Abstract: Crack-cocaine use facilitates HIV disease progression by reducing adherence in those on HAART and by accelerating disease progression independently of HAART.

Cited by 223 publications

References 32 publications

Risk Behaviors Among HIV-Positive Gay and Bisexual Men at Party-Oriented Vacations

Risk Behaviors Among HIV-Positive Gay and Bisexual Men at Party-Oriented Vacations

Levamisole-Contaminated Cocaine Use in HIV-Infected and Uninfected Unstably Housed Women

Immunosuppressive Effects of Opioids—Clinical Relevance

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