HIV/AIDS Pathogenesis; Drug Use Increases Risk of Opportunistic Infections Among HIV-Infected Women

Animal and in vitro studies suggest that cocaine and heroin use speed HIV replication and suppress immune function, though epidemiological studies remain inconclusive, Lorna E. Thorpe of CDC and colleagues wrote in a recent study. In their prospective study, researchers examined the association between illicit drug use and four outcome measures: CD4 cell percentage, HIV RNA levels, survival to class C diagnosis of HIV infection, and death. A national cohort of HIV-positive women was enrolled between 1989 and 1995 and were followed for five years and interviewed about their drug use. Up to three urine screens were conducted to validate self-reported drug use.

Of 1,148 women, 40 percent at baseline used hard drugs during pregnancy. "In multivariate analyses, hard-drug use was not associated with change in CD4 cell percentage (p=0.84) HIV RNA level (p=0.48), or all-cause mortality (relative hazard=1.10; 95% confidence interval, 0.61-1.98)." However, the hard-drug using women did have an increased risk of developing class C diagnoses -- especially herpes, pulmonary TB and recurrent pneumonia. The authors concluded, "Hard-drug using women may be at higher risk of developing nonfatal opportunistic infections."

The full report, "Effect of Hard-Drug Use on CD4 Cell Percentage, HIV RNA Level, and Progression to AIDS-Defining Class C Events Among HIV-Infected Women," was published in Journal of Acquired Immune Deficiency Syndromes (2004;37(3):1423-1430).

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