Article

Cook JA, Burke-Miller JK, Cohen MH, Cook RL, Vlahov D, Wilson TE, et al. Crack cocaine, disease progression, and mortality in a multicenter cohort of HIV-1 positive women

Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois 60612, USA.
AIDS (London, England) (Impact Factor: 6.56). 08/2008; 22(11):1355-63. DOI: 10.1097/QAD.0b013e32830507f2
Source: PubMed

ABSTRACT Longitudinal associations between patterns of crack cocaine use and progression of HIV-1 disease are poorly understood, especially among women. This study explores relationships between crack use and HIV-1 disease outcomes in a multicenter cohort of infected women.
Subjects were 1686 HIV-seropositive women enrolled at six US research centers in the Women's Interagency HIV Study. Approximately 80% were non-white and 29% used crack during the study period. Cox survival and random regression analysis examined biannual observations made April 1996 through September 2004. Outcome measures included death due to AIDS-related causes, CD4 cell count, HIV-1 RNA level, and newly acquired AIDS-defining illnesses.
Persistent crack users were over three times as likely as non-users to die from AIDS-related causes, controlling for use of HAART self-reported at 95% or higher adherence, problem drinking, age, race, income, education, illness duration, study site, and baseline virologic and immunologic indicators. Persistent crack users and intermittent users in active and abstinent phases showed greater CD4 cell loss and higher HIV-1 RNA levels controlling for the same covariates. Persistent and intermittent crack users were more likely than non-users to develop new AIDS-defining illnesses controlling for identical confounds. These results persisted when controlling for heroin use, tobacco smoking, depressive symptoms, hepatitis C virus coinfection, and injection drug use.
Use of crack cocaine independently predicts AIDS-related mortality, immunologic and virologic markers of HIV-1 disease progression, and development of AIDS-defining illnesses among women.

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Available from: Judith A. Cook, Jul 04, 2014
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    • "To our knowledge, no study has investigated the potential effects of cocaine use on the strategic component of verbal learning and underlying prefrontal activation patterns among HIV-infected individuals. Understanding the neural mechanisms underlying cognitive deficits associated with HIV and cocaine use is critically important given the high prevalence of use among HIV-infected individuals (Cook et al. 2008; Ostrow et al. 1993). Elucidating risk factors for HIV-associated cognitive deficits could have important implications for treatment outcomes, as cognitive impairment is associated with poor treatment adherence (Hinkin et al. 2004). "
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    ABSTRACT: Crack cocaine use is associated with impaired verbal memory in HIV-infected women more than uninfected women. To understand the neural basis for this impairment, this study examined the effects of crack cocaine use on activation of the prefrontal cortex (PFC) and strategic encoding during a verbal memory task in HIV-infected women. Three groups of HIV-infected women from the Chicago Consortium of the Women's Interagency HIV Study were compared: current users of crack cocaine (n = 10), former users of cocaine (n = 11), and women who had never used cocaine (n = 9). Participants underwent functional magnetic resonance imaging during a verbal memory task and completed a neuropsychological test of verbal memory. On the neuropsychological test, current crack users performed significantly worse than other groups on semantic clustering, a measure of strategic encoding, p < 0.05. During encoding, activation in left anterior cingulate cortex (ACC) was lower in current and former cocaine users compared to never users. During recognition, activation in bilateral PFC, specifically left dorsal medial PFC and bilateral dorsolateral PFC, was lower in current and former users compared to women who had never used cocaine. Lower activation in left dorsolateral PFC was correlated with worse performance on the recognition task, p < 0.05. The verbal learning and memory deficits associated with cocaine use in women with HIV may be partially accounted for by alterations in ACC and PFC function.
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    • "HIV-negative individuals who use stimulants report higher rates of sexual risk taking behavior and are at increased risk for contracting HIV as well as other sexually transmitted infections (Colfax et al., 2005; Koblin et al., 2006; Ostrow et al., 2009; Parsons and Bimbi, 2007; Shoptaw and Reback, 2007). Among HIV-positive persons, the use of stimulants has been associated with greater odds of engaging in HIV transmission risk behavior (Johnson et al., 2008; Morin et al., 2007), impaired HIV disease management (Carrico et al., 2011a; Carrico et al., 2007b; Carrico et al., 2011b; Ellis et al., 2003; Hinkin et al., 2007), and hastened HIV disease progression (Carrico, 2011; Cook et al., 2008). The co-occurrence of HIV transmission risk behavior and non-adherence to anti-retroviral therapy among HIV-positive stimulant users may also substantially contribute to the transmission of medication-resistant strains of the virus (Colfax et al., 2007; Gorbach et al., 2008; Kalichman, 2008). "
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    ABSTRACT: Prior research established that psychological factors are associated with the frequency of stimulant (i.e., cocaine, crack, and methamphetamine) use among substance-using men who have sex with men (MSM). The present investigation examined whether and how psychological factors are associated with engagement in any stimulant use in the broader population of MSM. A probability sample of 879 MSM residing in San Francisco was obtained using random digit dialing from May of 2002 through January of 2003. Of these, 711 participants (81%) completed a mail-in questionnaire that assessed psychological factors and substance use. After accounting for demographic factors, a multiple logistic regression analysis examined correlates of any self-reported stimulant use during the past 6 months. Path analyses examined if the use of alcohol or other substances to avoid negative mood states (i.e., substance use coping) mediated the associations of sexual compulsivity and depressed mood with stimulant use. Younger age (adjusted OR [AOR]=0.58; 95% CI=0.47-0.70), HIV-positive serostatus (AOR=2.55; 95% CI=1.61-4.04), greater depressed mood (AOR=1.26; 95% CI=1.05-1.52) and higher sexual compulsivity (AOR=1.46; 95% CI=1.18-1.80) were independently associated with increased odds of stimulant use. Substance use coping partially mediated the associations of sexual compulsivity (β(indirect)=0.11, p<.001) and depressed mood (β(indirect)=0.13, p<.001) with stimulant use. Clinical research is needed to examine if interventions targeting sexual compulsivity and emotion regulation reduce stimulant use among MSM.
    Drug and alcohol dependence 11/2011; 123(1-3):79-83. DOI:10.1016/j.drugalcdep.2011.10.020 · 3.28 Impact Factor
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    • "The present study examined cognitive impulsivity and brain functioning during a delay discounting task in HIV-positive adults with current, remitted, and no cocaine dependence. We investigated the effects of cocaine dependence because cocaine remains the most frequently abused illicit drug other than marijuana in HIV-positive adults (Cook et al., 2007; Korthuis et al., 2008; Kuo et al., 2004) and is associated with high levels of impulsivity (Coffey et al., 2003; Lejuez et al., 2005; Verdejo-Garcia et al., 2007). We hypothesized that active cocaine users would: (1) demonstrate greater delay discounting compared to recovered and naïve cocaine users; and (2) exhibit smaller increases in brain activation in prefrontal, anterior cingulate, and posterior parietal cortices during difficult choices relative to easy choices. "
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    ABSTRACT: Cocaine use is associated with poorer HIV clinical outcomes and may contribute to neurobiological impairments associated with impulsive decision making. This study examined the effect of cocaine dependence on brain activation during a delay discounting task involving choices between smaller immediate rewards and larger delayed ones. Participants were 39 HIV-positive adults on antiretroviral therapy who had current cocaine dependence ("active," n=15), past cocaine dependence ("recovered," n=13), or no lifetime substance dependence ("naïve," n=11). Based on responses on a traditional delay discounting task, three types of choices were individualized for presentation during functional magnetic resonance imaging: hard (similarly valued), easy (disparately valued), and no (single option). Active participants had significantly smaller increases in activation than naïve participants during hard versus easy choices bilaterally in the precentral gyrus and anterior cingulate cortex and in the right frontal pole (including dorsolateral, ventrolateral, and orbitofrontal cortex). During hard and easy choices relative to no choices, active participants had smaller increases in activation compared to naïve participants in frontoparietal cortical regions. These deficits in the executive network during delay discounting choices may contribute to impulsive decision making among HIV-positive cocaine users, with implications for risk behaviors associated with disease transmission and progression.
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