title: Levamisole-Contaminated Cocaine Use in HIV-Infected and Uninfected Unstably Housed Women.
abstract: A growing number of case reports cite serious health complications linked to the cocaine adulterant, levamisole and women are disproportionately affected; however, the clinical effects are not well established. Between April and October of 2010, we conducted a cross-sectional study among 222 homeless and unstably housed women (116 human immunodeficiency virus [HIV]-infected and 106 HIV-uninfected). Immune markers and behavioral factors were compared in separate models by cocaine and levamisole exposure. Overall, 63% of participants were toxicology positive for cocaine/benzoylecgonine, 85% of whom also tested positive for levamisole. Differences in immune markers did not reach levels of significance among HIV-uninfected persons. Compared to HIV-infected persons who were negative for both cocaine and levamisole, the adjusted odds of low white blood cell count were significantly higher among HIV-infected persons positive for both (p = 0.03), but not for those positive for cocaine only. Neutrophil count and HIV viral load did not differ by cocaine and levamisole status among HIV-infected persons. In a separate model, the adjusted odds of testing positive for levamisole were higher among African American women compared to Caucasian and Asian women (p = 0.02). In the context of high levamisole prevalence, results suggest that decreased immune function as a result of levamisole exposure occurs mainly in individuals who are already immune compromised (e.g., HIV-positive), and race/ethnicity appears to be an important factor in understanding levamisole exposure among cocaine-using women. While larger and geographically diverse studies are needed to elucidate these initial findings, results suggest that levamisole may be one mechanism of immune dysfunction in HIV-infected cocaine-using women.
authors.affiliation: 1 Department of Medicine, University of California , San Francisco, San Francisco, California.
authors.forename: Elise D
authors.initials: ED
authors.lastname: Riley
authors.affiliation: 2 RTI International, Behavioral and Urban Health Program , San Francisco, California.
authors.forename: Alex H
authors.initials: AH
authors.lastname: Kral
authors.affiliation: 3 Department of Clinical Pharmacy, University of California , San Francisco, San Francisco, California.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Cohen
authors.affiliation: 1 Department of Medicine, University of California , San Francisco, San Francisco, California.
authors.forename: Samantha E
authors.initials: SE
authors.lastname: Dilworth
authors.affiliation: 4 Department of Psychiatry, University of California , San Francisco, San Francisco, California.
authors.forename: Martha
authors.initials: M
authors.lastname: Shumway
authors.affiliation: 5 Department of Laboratory Medicine, University of California , San Francisco, San Francisco, California.
authors.forename: Kara L
authors.initials: KL
authors.lastname: Lynch
mesh_terms: D000328:Adult; D000969:Antinematodal Agents / Q000506:poisoning; D015415:Biomarkers / Q000032:analysis; D002140:California / Q000453:epidemiology; D003042:Cocaine / Q000506:poisoning*; D019970:Cocaine-Related Disorders / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D004340:Drug Contamination; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006801:Humans; D007978:Levamisole / Q000506:poisoning*; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D057566:Self Report
chemical_list: D000969:Antinematodal Agents; D015415:Biomarkers; D007978:Levamisole; D003042:Cocaine