People who use cocaine are less likely to take their anti-HIV medication properly, according to an American study published in the May 2002 edition of the Journal of General Internal Medicine.
Investigators at the Montefiore Medical Center in New York used electronic monitors to measure adherence to HAART regimens in 85 HIV-positive current and former drug users. The investigators found that risk factors for poor adherence included cocaine use, being female, being single, the use of alcohol and drugs to relieve stress, depression, and not accessing social security benefits.
Of all the risk factors, cocaine use was mostly strongly linked with poor adherence, with only 27% of cocaine users maintaining adherence over the six-months of the study, compared to 68% of people who did not report cocaine use. Only 13% of cocaine users achieved an undetectable viral load (below 400copies/ml) compared to 46% of non-users.
The investigators recommend that interventions to improve adherence should focus on reducing cocaine use, developing coping strategies and identifying and treating depression.
The study did not report on whether poor adherence resulted in faster disease progression amongst cocaine users. Research published in February 2002 found that HIV infected mice given cocaine lost CD4 T cells more rapidly. This seems to support earlier data from a cohort study of HIV-positive gay men that found faster disease progression and death in cocaine users, although cocaine users may have been more likely to have other risk factors such as poor nutrition and disrupted sleep patterns.
Amsten, JH et al. Impact of drug use on antiretroviral therapy adherence and viral suppression in HIV-infected drug users. Journal of General Internal Medicine 15 (5):377-381, 2002.