Response from Dr. Frascino
Hello,
Cocaine is one of the most addictive and destructive substances known to humankind. Yes, there are both medical and emotional consequences to using coke. It's time to have a heart-to-heart talk with your boyfriend. He may well already need professional help to get off and stay off coke. Show him this post and my response. One of the first things he may lose to coke (even before his health, sanity, money and life) is you! (See below.)
Good luck to you both.
Dr. Bob
Cocaine and HIV
Feb 21, 2005
Dr. Bob: You have stated "Cocaine can increase HIV replication by 200 times! It may also increase the number of receptors (CCR5 and CXCR4) on CD4 cells that HIV uses to infect these cells." I have been injecting cocaine for the past 5 years. My t-cells have varied little (400+)and my viral load has remained undetectable during that time. I am on a 4-drug HAART and have been fairly adherent to the regimen throughout. Can you explain why the cocaine doesn't seem to be increasing my HIV???
Anonymous in Chicago
Response from Dr. Frascino
Hi Anonymous in Chicago,
You answered your own question. You are on "4-drug HAART and have been fairly adherent to your regimen throughout." So the cocaine may indeed be trying to rev up you HIV-replication mechanisms just as your potent antiretroviral medications are trying to slow it down. It's a bit like trying to drive with one foot firmly on the break and the other pushing on the gas pedal. As you can imagine, that's not so good for your car's engine. Likewise, what you are doing to your body with cocaine is also not good and will eventually take its toll.
The next step is up to you. I'd suggest that if you want to keep HIV in check, you take your foot off the gas pedal and thank your lucky starts you haven't already ruined your transmission.
Drive safely, Anonymous Guy.
Dr. Bob
HIV Risk Seen in Cocaine
January 19, 2007
A recent study found cocaine and other stimulants not only impair the brain's judgment center, but they also enhance sexual desire, increasing the likelihood of risky sex. The effect was observed among study participants with a drug dependence history as well as those without one, reported Brookhaven National Laboratory (BNL) researchers.
The study enrolled 100 men, half with and half without a cocaine dependence history. An intravenous tube delivered Ritalin to half the men and a placebo to the remainder. The stimulant Ritalin, an attention-deficit disorder drug prescribed for children, is more potent and mimics the effects of cocaine when administered intravenously.
Test participants were asked before and after the administration of Ritalin or placebo to rank their sexual desire on a scale from one to 10. The men's brains were also scanned during the trial. Men with and without a drug dependence history who received Ritalin reported enhanced sexual desire. The placebo group reported no change in desire.
Besides needle-sharing as an HIV risk factor, "we have shown that the drugs themselves contribute to this risk," said Dr. Nora Volkow, a co-author and former BNL researcher now with the National Institute on Drug Abuse. "When people get intoxicated [by these drugs], it decreases their inhibition, and it enhances sexual desire," she said. "Drugs inhibit the ability to control these desires."
"Stimulants can directly enhance sexual desire even in environments where there is no sexual stimulation," said Volkow. That can lead drug users into impulsive behavior, putting them at high risk for STDs, HIV or hepatitis C infection, said researchers.
The full report, "Stimulant-Induced Enhanced Sexual Desire as a Potential Contributing Factor in HIV Transmission," was published in the American Journal of Psychiatry (2007;164:157-160).
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