A new study concludes, "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."

The subjects of the research were 1,686 HIV-positive women enrolled at six US research centers in the Women's Interagency HIV Study. During the study period, April 1996 to September 2004, 29 percent used crack. The researchers recorded 419 deaths: 47 percent were AIDS-related; 33 percent were not AIDS-related; and 20 percent were classified as "indeterminate."

Thirty-two percent of the women acquired a new AIDS-defining illness during the study: These included 42 percent of intermittent crack users, 39 percent of persistent users, and 28 percent of non-users. In active as well as abstinent phases, the crack users showed greater CD4 cell loss and higher HIV levels.

"Persistent crack users were over three times as likely as non-users to die from AIDS-related causes, controlling for use of [highly active antiretroviral therapy] self-reported at 95 percent or higher adherence, problem drinking, age, race, income, education, illness duration, study site, and baseline virologic and immunologic indicators," the authors wrote. The results persisted after controlling for heroin use, tobacco smoking, depressive symptoms, co-infection with hepatitis C, and drug injecting.

"Since 100 percent of the women using crack in our cohort reported receiving medical care in the past six months, and over 90 percent saw the same health care provider consistently, physicians can serve as important conduits to the multiple services these women need," said lead author Judith A. Cook of the University of Illinois-Chicago.

The report, "Crack Cocaine, Disease Progression, and Mortality in a Multicenter Cohort of HIV-1 Positive Women," was published in AIDS (2008;22(11):1355-1363).

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