HIV-infected patients who persistently use cocaine and heroin are at increased risk of opportunistic infections, disease progression, and death compared with nonusers, investigators in Baltimore report. While they are using, the risk is just as high in intermittent drug users as in persistent users, but the risk drops during periods of abstinence.

To assess the association of drug use with HIV disease progression, Dr. Gregory M. Lucas at the Johns Hopkins University School of Medicine, and his associates surveyed patients every 6 months using confidential computer-based interviews, starting in 1998.

As reported in the American Journal of Epidemiology, the 1,851 study participants included 1,028 nonusers, 588 intermittent users (defined as using drugs an average of 14 days in the past 6 months), and 235 persistent users (using drugs an average of 27 days in the past 6 months).

At 3 years, the estimated survival rates were 87 percent for nonusers, 80 percent for intermittent users and 68 percent for persistent users.

After adjustment the data for age, race, gender, lowest CD4 cell count and highest HIV level, the risk of death was almost twice as high in intermittent users and close to three times as high in persistent users.

During periods of abstinence, the risk of developing new opportunistic infections was similar to that of nonusers. The risk was closer to that of persistent users when intermittent users were actively using drugs. Similar associations were observed for HIV disease progression.

Lucas’s team theorizes that the effects of drug abuse on disease progression may be related to biological effects, such as increased HIV replication and impaired lymphocyte function, or reduced access to care and poor adherence to therapy.

Treatment that combines HIV, substance abuse and psychiatric treatment should be stressed for patients who use cocaine or heroin, the authors recommend. Buprenorphine for opioid dependence may be particularly helpful for these patients, they add.

SOURCE: American Journal of Epidemiology, March 1, 2006.