Smoking crack may speed up HIV course in women

Women infected with HIV, the virus that causes AIDS, who use crack cocaine risk deterioration in their immune status, development of "AIDS-defining" illnesses, and death from AIDS-related causes, even if they adhere to potent combination antiretroviral therapy used to treat HIV infection.

The findings stem from a study of 1,686 HIV-infected women, 29 percent of whom used crack cocaine during the study period (April 1996 to September 2004).

According to Dr. Judith A. Cook from the University of Illinois at Chicago and colleagues, 419 women died during the study period; 47 percent of these deaths were related to AIDS, 33 percent were not related to AIDS, and 20 percent were "indeterminate."

Results showed that persistent crack cocaine users were over three times as likely as non-crack users to die from AIDS-related causes.

Among all 1,686 women, 32 percent were found to have a newly acquired AIDS-defining illness during the study period; significantly higher proportions of intermittent (42 percent) and persistent crack cocaine users (39 percent) reported a new illness during this time than did non-users (28 percent), according to the researchers.

Intermittent and persistent crack users in active and abstinent phases also showed greater decline in immune function and higher blood levels of HIV.

This is the first study, the researchers say, linking use of crack cocaine in a large, national cohort of HIV-positive women to subsequent deterioration in immune status, failure of suppress the virus, development of AIDS-defining conditions, and death due to AIDS-related causes.

"Our findings," Cook said, "suggest that a multi-pronged research agenda is needed to understand the effects of crack cocaine on HIV disease progression."

"Since 100 percent of the women using crack in our cohort reported receiving medical care in the past 6 months, and over 90 percent saw the same healthcare provider consistently, physicians can serve as important conduits to the multiple services these women need," she added.

SOURCE: AIDS, July 11, 2008.