ABSTRACT

1. The Impact of Heroin/Cocaine Abuse in the Progression of HIV Disease Among Females: Results from the Wings Clinic Women’s Cohort (WCWC) Study Fabiola Gianella, Rebecca Ford, Jorge Perez, Lala Hussain, Alice Gunnison, Julie Harting, Robert Kelley Division of Infectious Diseases, University of Louisville ABSTRACT INTRODUCTION (Cont’d) MATERIALS AND METHODS (Cont’d) CONCLUSIONS Introduction: HIV infection is prevalent among substance abusers. The effect of specific illicit drugs on HIV outcomes in females is poorly understood. The objective of this study is to explore the effect of heroin and cocaine abuse on HIV disease progression among HIV infected women. Methods: This was a retrospective observational study of HIV-infected female patients managed at the Wings Clinic in Louisville, KY from 2006 to 2011. Patients where characterized as heroin/cocaine abusers versus non-drug abusers according to self-report in the medical record. HIV disease progression was evaluated by median CD4+ cell count in each year of the study period. Results: A total of 164 HIV-seropositive females were included in the study. Heroin/cocaine abuse was documented in 17 patients.. Conclusions: This study failed to demonstrate any significant difference in HIV disease progression for females using heroin/cocaine versus females not abusing illicit drugs. This suggests more rapid HIV disease progression among drug users found in other studies may not be due to the illicit drug itself, but may be due to other confounding factors such as medication compliance or homelessness. We need to increase the sample size. Further studies would be needed. • This study failed to demonstrate any significant difference in HIV disease progression for females using heroin/cocaine versus females not abusing illicit drugs. This suggests more rapid HIV disease progression among drug users found in other studies may not be due to the illicit drug itself, but may be due to other confounding factors such as medication compliance or homelessness. • Our findings are similar with findings of Rompalo et al…2004, who found that injection drug use per se did not seem to result in faster progression to AIDS and speculated that lower use of HAART among IV drug users might have accounted for the poorer outcomes that they observe among this group.4 Statistical Analysis: We built the 2x2 table and used fisher exact test to do the analysis with p- value< 0.05 women.4 Another large multi-site cohort study (Women and Infant Transmission Study [WITS]) found that hard drug use (i.e., cocaine, heroin, methadone, or injecting drugs) was significantly associated with AIDS-defining illnesses, but hard drug users and non-users did not differ on other progression outcomes such as change in CD4, HIV-RNA, or all cause mortality.5 In a third large multi-site cohort of HIV-infected women (Women’s Interagency HIV Study [WIHS], non- injection drug user (NIDU) were associated with HIV progression to AIDS and all-cause mortality.6 In a forth study, focusing exclusively on self-reported use of smoked crack cocaine from WIHS cohort, the 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.7 RESULTS Heroin/cocaine abuse was documented in 17 patients. The results of the study are shown in Figure 1 and Tables 1 and 2. Figure 1: Comparison of the trends in CD4+ cell count REFERENCES 1.-Kral AH, Bluthenthal RN, Booth RE, Watters JK. HIV seroprevalence among street-recruited injection drug and crack cocaine users in 16 US municipalities. Am J Public Health. 1998 Jan;88(1):108-13 2.- Donahoe RM, Nicholson JK, Madden JJ, Donahoe F, Shafer DA, Gordon D, Bokos P, Falek A. Coordinate and independent effects of heroin, cocaine, and alcohol abuse on T-cell E-rosette formation and antigenic marker expression. Clin ImmunolImmunopathol. 1986 Nov;41(2):254-64. 3.- Hung C, Leftkowitz S, Geber W. Interferon inhibition by narcotics analgesics. ProcSocExpBiol Med. 1973; 142: 106- 111 4.- Rompalo AM, Shah N, Margolick JB, Farzadegan H, Arnsten J, Schuman P, Rich JD, Gardner LI, Smith DK, Vlahov D. Evaluation of possible effects of continued drug use on HIV progression among women. Int J STD AIDS. 2004 May;15(5):322-7. 5.- Thorpe LE, Frederick M, Pitt J, Cheng I, Watts DH, Buschur S, Green K, Zorrilla C, Landesman SH, Hershow RC. Effect of hard-drug use on CD4 cell percentage, HIV RNA level, and progression to AIDS-defining class C events among HIV-infected women. J Acquir Immune Defic Syndr. 2004 Nov 1;37(3):1423-30. 6.- Kapadia F, Cook JA, Cohen MH, Sohler N, Kovacs A, Greenblatt RM, Choudhary I, Vlahov D. The relationship between non-injection drug use behaviors on progression to AIDS and death in a cohort of HIV seropositive women in the era of highly active antiretroviral therapy use. Addiction. 2005 Jul;100(7):990-1002 7.- Cook JA, Burke-Miller JK, Cohen MH, Cook RL, Vlahov D, Wilson TE, Golub ET, Schwartz RM, Howard AA, Ponath C, Plankey MW, Levine AM, Grey DD. Crack cocaine, disease progression, and mortality in a multicenter cohort of HIV-1 positive women. AIDS. 2008 Jul 11;22(11):1355-63. MATERIALS AND METHODS Table 1: Contingency Table for Drugs/Infections or Malignancies • Study Design and Study subjects • This was a retrospective observational study of 164 HIV-infected female patients managed at the Wings Clinic in Louisville, KY from 2006 to 2011. • Study Definitions: • Predictor variables: Patients where characterized as heroin/cocaine abusers versus non-drug abusers according to self-report in the medical record • Outcomes Variables: median CD4+ cell count in each year of the study period INTRODUCTION HIV infection is prevalent among substance abusers.1 Most in vitro and animals studies have shown decreases in immune system after exposure to hard drugs, namely heroin, cocaine and methadone .2-3The effect of specific illicit drugs on HIV outcomes in females is poorly understood. There are a mixed of different results in the studies of drug users in exclusively females U.S. cohorts. In a multi-center cohort of 693 HIV-positive women (HIV Epidemiology Research Study [HERS]), neither injection drug use nor frequency of injection drug use was associated with progression to AIDS among HIV infected P-Value = 1 Table 2: Contingency Table for Drugs/CD4 Count P-Value=.5944