New Evidence on Intravenous Cocaine Use and the Risk of Infection with Human Immunodeficiency Virus Type 1

Abstract

To examine whether recent intravenous use of cocaine might be associated with increased risk of human immunodeficiency virus type 1 (HIV) infection, the authors studied 2,597 active intravenous drug users: 2,399 with recent cocaine injection and 198 with recent injection of heroin or other drugs but not cocaine. These subjects were adult residents of Baltimore City and the surrounding Maryland counties, recruited via outreach into the community between February 1988 and March 1989. In contrast to the first report on the cocaine-HIV association, the present study sample was not recruited solely from drug treatment programs. In the present study, estimated HIV seroprevalence was 26.4% for recent cocaine injectors as compared with 10.6% among all other recent intravenous drug users; the relative odds estimate was 3.03. In the untreated segment of the sample, HIV seroprevalence was 26.0% for recent cocaine injectors as compared with 8.9% among others (relative odds (RO) = 3.61). The estimated degree of association did not change appreciably when multiple logistic regression was used to hold constant potentially confounding and/or mediating variables such as receptive anal intercourse, number of sex partners, and use of injection equipment obtained at shooting galleries (RO = 2.64). Augmenting these cross-sectional data, preliminary prospective data showed excess risk of HIV seroconversion among recent cocaine injectors (estimated relative risk = 2.11). While other research has examined the cocaine-HIV association, the present study differs in that it has allowed a test for whether the association was a spurious artifact of studying drug users recruited solely from drug treatment programs, a broad array of alternative determinants of HIV infection have been held constant, and the association has been examined with seroconversion data. The results lend support to the abiding concern about the risk of HIV infection among cocaine users.

Cocaine Dependence and Acute Cocaine Induce Decreases of Monocyte Proinflammatory Cytokine Expression across the Diurnal Period: Autonomic Mechanisms

“…Moreover, circulating levels of IL-6 are lower in hepatitis C-infected persons compared with hepatitis C-negative controls (Lee et al, 2002), and levels IL-6 are higher in patients who respond to interferon-␣ treatment (Mazur et al, 2001). Likewise, a decrease in the ability of monocytes to express IL-6 may also have implications for primary and early HIV infection (Chaisson et al, 1989;Anthony et al, 1991;Deeks et al, 2004). Cocaine increases HIV replication in peripheral blood mononuclear cells in vitro (Bagasra and Pomerantz, 1993), whereas IL-6 has been shown to suppress HIV-1 replication in mixed brain cell cultures (Lokensgard et al, 1997).…”

Risk Factors Associated with the Transition with Transition to Heroin Injection: A Street Addict Role Perspective

“…Current and retrospective selfreporting of high risk behaviors have been shown to be valid and reliable in drug using populations. [39][40][41] Misclassification errors are a constant threat in case-control studies. This study employed a rigorous screening protocol, which included urine tests for the presence of heroin and cocaine, physical examination for track marks by a phlebotomist, and consistency of self-report with staff knowledge of street behavior to maximize the accuracy of classification.…”

Microbial Infections, Immunomodulation, and Drugs of Abuse

“…Much of the work with cocaine and infections has been centered on HIV and progression to AIDS (13). Epidemiologic studies on IVDUs and AIDS link abuse of cocaine, even more than other drugs, to increased incidence of HIV seroprevalence and progression of AIDS (7,37,42,56). Cocaine increases HIV infection of human PBMCs in vitro (12,177).…”