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: 5.55). 08/2008; 22(11):1355-63. DOI: 10.1097/QAD.0b013e32830507f2
Source: PubMed


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.

Download full-text


Available from: Judith A. Cook, Jul 04, 2014
  • Source
    • "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). "
    [Show abstract] [Hide abstract]
    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.
    Full-text · Article · Apr 2014 · Journal of NeuroVirology
  • Source
    • "Among HIV-negative men who have sex with men (MSM), those who use stimulants are more likely to report engaging in sexual risk-taking behavior and are at elevated risk for HIV seroconversion.1–3 It is also well-established that HIV-positive stimulant users are more likely to experience difficulties with HIV disease management which lead to elevated HIV viral load and potentially faster mortality.4–7 These difficulties with HIV disease management often co-occur with HIV transmission risk behavior, 8,9 which could contribute to the onward transmission of medication-resistant strains of HIV.10,11 "
    [Show abstract] [Hide abstract]
    ABSTRACT: Harm reduction approaches endeavor to assist individuals with avoiding the most detrimental consequences of risk taking behaviors, but limited research has documented the outcomes of harm reduction substance abuse treatment. In total, 211 methamphetamine-using men who have sex with men (MSM) enrolled in two outcome studies of substance abuse treatment programs that were implementing an evidence-based, cognitive-behavioral intervention (i.e., the Matrix Model) from a harm reduction perspective. Study 1 (N = 123) examined changes in self-reported substance use, Addiction Severity Index (ASI) composite scores, and HIV care indicators over a 12-month follow-up. Study 2 (N = 88) assessed changes in substance use, sexual risk taking, and HIV care indicators over a 6-month follow-up. Participants in study 1 reported reductions in cocaine/crack use as well as decreases in the ASI drug and employment composite scores. Among HIV-positive participants in study 1 (n = 75), 47 % initiated or consistently utilized anti-retroviral therapy and this was paralleled by significant increases in self-reported undetectable HIV viral load. Study 2 participants reported reductions in methamphetamine use, erectile dysfunction medication use in combination with other substances, and sexual risk-taking behavior while using methamphetamine. Participants in both studies reported concurrent increases in marijuana use. Taken together, these studies are among the first to observe that clients may reduce stimulant use and concomitant sexual risk-taking behavior during harm reduction substance abuse treatment. Randomized controlled trials are needed to examine the differential effectiveness of harm reduction and abstinence-based approaches to substance abuse treatment.
    Full-text · Article · Apr 2014 · Journal of Urban Health
  • Source
    • "Cook, et al., in a review article on the use of crack cocaine and progression of the disease in patients living with HIV, confirmed that cocaine is associated with immune changes in a variety of lymphocytes, including the natural killer cells, CD4 and CD8. They suggested, based on studies by Baldwin et al, that cocaine inhibits the effector function of neutrophils and macrophages, as well as reduces cytokine production, decreasing the immune response [27]. In two cohorts that aimed to assess the effect of marijuana on the immune response of patients living with HIV, there was no statistically significant association between the two variables [24], [29], in contrast to our findings in the univariate analysis. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The measurement of CD4+ T-cell (CD4) counts is a strong predictor of progression to AIDS and a means of monitoring antiviral therapy (ART). The success or failure of controlling virus levels in untreated patients or those taking ART may be associated with treatment adherence, habits, correlated infections unrelated to HIV, cancer, immunosuppressive drugs; as well as socio-economic and psychosocial aspects and access to healthcare. The aim of the present study was to identify, using a multilevel model, the factors related to the variations of CD4 counts over time, in patients living with HIV. A cohort study was conducted with patients living with HIV, selected from July 2007 to December 2010. Patients were monitored from records of their first CD4 count after being diagnosed with HIV. A multilevel model with 3 levels of aggregation was applied to analyze the associations of predictor variables and the behavior of CD4 over time. A total of 1870 patients were enrolled. The mean number of CD4 at the beginning of the cohort was 393.1 cells/mm(3), and there was a mean increase of 1.529 cells/mm(3) per month. Patient's age, smoking, use of illicit drugs, hospital treatment, changing doctors and the use of ART, were factors that affected the kinetics of the CD4 count during the follow-up period. The results of this study indicated increased levels of CD4 over time in a cohort of patients living with HIV/AIDS and identified factors that may influence this increase and are liable to intervention.
    Full-text · Article · Feb 2014 · PLoS ONE
Show more