Crack cocaine, disease progression, and mortality in a multicenter cohort of HIV-1 positive women.
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.


CONCLUSIONS
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.
Cook
Judith A
JA
Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois 60612, USA. cook@ripco.com
Burke-Miller
Jane K
JK
Cohen
Mardge H
MH
Cook
Robert L
RL
Vlahov
David
D
Wilson
Tracey E
TE
Golub
Elizabeth T
ET
Schwartz
Rebecca M
RM
Howard
Andrea A
AA
Ponath
Claudia
C
Plankey
Michael W
MW
Levine
Alexandra M
AM
Levine
Andrea
A
Grey
Dennis D
DD
D000328:Adult; D018791:CD4 Lymphocyte Count; D019970:Cocaine-Related Disorders / Q000150:complications* / Q000401:mortality; D016578:Crack Cocaine; D018450:Disease Progression; D004812:Epidemiologic Methods; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000276:immunology / Q000401:mortality / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D008875:Middle Aged; D011379:Prognosis; D012367:RNA, Viral / Q000097:blood; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D019562:Viral Load
D016578:Crack Cocaine; D012367:RNA, Viral