Background: 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.
Methods: 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.
Results: 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.
Conclusion: 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.
From the aDepartment of Psychiatry, University of Illinois at Chicago, USA
bCore Center and Stroger (formerly Cook County) Hospital, Chicago, Illinois, USA
cCollege of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
dNew York Academy of Medicine, New York, USA
eDepartment of Preventive Medicine and Community Health, State University of New York Downstate Medical Center, Brooklyn, New York, USA
fDepartment of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
gInternational Center for AIDS Care and Treatment Programs, Mailman School of Public Health, Columbia University, New York, USA
hDepartment of Clinical Pharmacy, University of California at San Francisco, San Francisco, California, USA
iDepartment of Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA
jCity of Hope, Duarte, California, USA.
Received 8 October, 2007
Revised 10 March, 2008
Accepted 16 April, 2008
Correspondence to Judith A. Cook, PhD, Center on Mental Health Services Research and Policy, Department of Psychiatry, University of Illinois at Chicago, 1601 W. Taylor St, 4th Floor M/C912, Chicago, IL 60612, USA. Tel: +1 312 355 3921; fax: +1 312 355 4189; e-mail: firstname.lastname@example.org