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Recreational Drugs and HIV/AIDS

There has long been an association between recreational drugs and AIDS. Surprisingly, some of the strongest associations are not with injection drugs, but with inhalant nitrites, widely marketed to and used by gay men, and with non-injection forms of cocaine, such as ‘crack’. This information is largely ignored by people who accept the infectious theory of AIDS, perhaps because this evidence does not fit that theory.

The quotes are classified as:

Cocaine use and HIV/AIDS

Cocaine use is closely associated with the risk of testing positive for HIV and having AIDS - even if the usage is non-injection!

“Levamisole is a known contaminant of cocaine and, via this route, has been associated with otherwise unexplained agranulocytosis [deficiency of certain types of white blood cells]. Levamisole is currently present in the majority of cocaine samples seized by the US Drug Enforcement Agency…Agranulocytosis, defined as an absolute neutrophil count of less than 500/ÁL, places an affected patient at increased risk of morbidity and mortality related to infectious complications [i.e. it is seriously immunosuppressive]…a large proportion of otherwise unexplained cases of agranulocytosis occur in patients with known recent cocaine ingestion; moreover, multiple lines of evidence point to the contaminant levamisole as the responsible etiologic agent…””
Czuchlewski DR et al. Clinicopathologic features of agranulocytosis in the setting of levamisole-tainted cocaine. Am J Clin Pathol. 2010 Mar;133(3):466-72.
http://ajcp.ascpjournals.org/content/133/3/466.long
“The Winnipeg Regional Health Authority has issued a warning after two adults were hospitalized with an illness likely caused by cocaine laced with a veterinary drug. The patients were suffering from neutropenia, also known as agranulocytosis, a serious illness that impacts immune systems, leaving them unable to fight off infections, the WRHA stated in a press release. In severe cases, if left untreated, the disease can be fatal. It is believed both patients, known cocaine users, became ill as a result of using cocaine laced with levamisole.”
Tainted cocaine linked to illnesses in Winnipeg. CBC News. 2010 Feb 5
http://www.cbc.ca/health/story/2010/02/05/mb-tainted-cocaine-winnipeg.html?ref=rss
“Data from 1686 women were analyzed: 1203 (71.4%) were categorized as non-users, 429 (25.4%) as intermittent users, and 54 (3.2%) as persistent users of crack [cocaine]…There were 419 deaths during the follow-up period: 197 (47.0%) were AIDS-related, 138 (33.0%) were non- AIDS-related, and 84 (20.0%) were indeterminate…In a Cox proportional hazards model adjusting for age, race, income, education, problem drinking, adherent HAART-use, CD4 cell count less than 200 cells/Ál at baseline, HIV-1 RNA level more than 100 000 copies/ml at baseline, illness duration, and study site, compared with that for non-users, the risk of AIDS-related death was significantly higher for persistent users but not for intermittent users. Of the total group of 1686 women, 543 (32.2%) were found to have a newly acquired AIDS-defining illness during the follow-up period. Significantly higher proportions of intermittent users (42.0%) and persistent users (38.9%) reported a new illness during this time period than did non-users (28.4%). The most frequently reported AIDS-defining illnesses were bacterial pneumonia (18% of all cases), pneumocystis carinii pneumonia (10%), herpes simplex virus, non-pulmonary (9%), esophageal candidiasis (9%), cryptosporidiasis (6%), dementia/ encephalopathy (5%), wasting syndrome (5%), and tuberculosis (4%). Among these, persistent and/or intermittent users were [statistically] significantly more likely than non-users to report bacterial pneumonia, tuberculosis, and esophageal candidiasis…Throughout most of the study period, those reporting persistent crack use had higher viral load and poorer immune function, whereas those reporting no use had the lowest HIV-1 RNA levels and best immune health, with intermittent crack users falling in between…persistent crack use, intermittent-active, and intermittent-abstinent crack use were significantly associated with HIV disease progression, controlling for adherent HAART use, problem drinking, women’s sociodemographic characteristics, study site, illness duration, baseline viral load (in the CD4 model), and baseline CD4 cell count (in the viral load model). Persistent problem drinking was positively associated with disease progression defined by high viral load but not low CD4 cell count. In both models, adherent HAART use was protective against disease progression [an invalid statement, they can show an association, but this implies causation]…We found that the median reduction in HIV-1 RNA level was highest in non-users, at 1.7 log10 copies/Ál, compared with 1.4 log10 copies/Ál in inactive crack users and 1.0 log10 copies/Ál in active users. The median CD4 cell count increase was highest in non-users, at 161 cells/Ál, compared with 123 cells/Ál in inactive users, and 100 cells/Ál in active users. ”
Cook JA et al. Crack cocaine, disease progression, and mortality in a multicenter cohort of HIV-1 positive women. AIDS. 2008 Jul 11;22(11):1355-63.
“self-report of past substance abuse was significantly greater for cocaine and heroin use in the co-infected [Hepatitis C and HIV] than in the mono-infected [HIV only] group [i.e. 90% of the co-infected group had used cocaine, versus 59.6% in the mono-infected group and 35% had used Heroin, versus 12.8%. All other rates except cannabis were higher, but not statistically significant]…prior to antiretroviral therapy, HCV+/HIV+ co-infected participants [almost all previous cocaine abusers] had significantly poorer visual memory and manual dexterity than did the HIV+ mono-infected participants.”
Parsons TD et al. Neurocognitive functioning and HAART in HIV and hepatitis C virus co-infection. AIDS. 2006 Aug 1;20(12):1591-5.
“The consumption of some drugs has been proved to be a risk factor that alters the normal immune function, and could be involved in the lack of immunological response in patients treated with HAART…[in this study] A total of 176 patients (61%) had acquired HIV-1 infection through intravenous drug use. These individuals had a significantly worse CD4 [immune] cell count recovery, which remained significantly different through all the study period…In our series, intravenous drug use and not HCV [Hepatitis C virus] co-infection determined the amount and speed of the increase in CD4 cells counts…The relationship between illicit drug use and the immune system has previously been established and supports our findings. Opiates and cocaine can suppress the functional activities of human peripheral blood mononuclear cells, which are known to play a key role in host defence against intracellular opportunistic pathogens…In summary, a long-term poorer increase in the CD4 cell count despite a successful virological suppression is more frequently observed in naive HIV-1-infected patients who acquired their infection by injecting drug use.”
Dronda F et al. CD4 cell recovery during successful antiretroviral therapy in naive HIV-infected patients: the role of intravenous drug use. AIDS. 2004;18(16):2210-2.
“In the bivariate analysis, factors positively associated with HIV seroconversion included: injecting cocaine at least weekly, borrowing used needles [although Table 1 shows that this is negatively associated with HIV seroconversion!], incarceration, unstable housing, methadone maintenance treatment, more than 20 lifetime sex partners, and receiving payment for sex. In the multivariate analysis injecting cocaine remained the strongest predictor of HIV seroconversion [3.72 times the average risk]…The weekly use of crack cocaine was inversely associated with HIV seroincidence. Frequent heroin use was not associated with HIV seroconversion.”
Tyndall MW et al. Intensive injection cocaine use as the primary risk factor in the Vancouver HIV-1 epidemic. AIDS. 2003 Apr 11;17(6):887-93.
“Cocaine abuse is associated with increased rates of infections, including human immunodeficiency virus, and cocaine has immunomodulatory effects in experimental animal and cellular models…30 healthy men and women with a history of cocaine use participated in this study of neuroendocrine and immunological responses to iv injection of 0.4 mg/kg cocaine or saline placebo…Stimulation of IL-6 at 240 min was markedly reduced in subjects receiving cocaine compared with subjects receiving placebo…Because cocaine stimulates the hypothalamic-pituitary-adrenal axis, IL-6 suppression may be a consequence of corticosteroid release. Cocaine-induced suppression of proinflammatory IL-6 may mediate impaired host defenses to infections.”
Halpern JH et al. Diminished interleukin-6 response to proinflammatory challenge in men and women after intravenous cocaine administration. J Clin Endocrinol Metab. 2003 Mar;88(3):1188-93.
“Human alveolar macrophages (AMs) were recovered from the lungs of healthy nonsmokers (NS) or smokers of tobacco (TS), marijuana (MS), or crack cocaine (CS) and challenged in vitro with Staphylococcus aureus…AMs from MS and CS exhibited minimal antibacterial activity and failed to produce NO [Nitrous Oxide, an important signaling compound used by the immune system] unless primed with additional cytokines.”
Shay AH et al. Impairment of antimicrobial activity and nitric oxide production in alveolar macrophages from smokers of marijuana and cocaine. J Infect Dis. 2003 Mar 15;187(4):700-4.
“Cocaine-induced oxidative stress appears to involve decreased glutathione and lipid peroxidation, potentiating the oxidative stress associated with HIV-1 infection.”
Shor-Posner G et al. Neuroprotection in HIV-positive drug users: implications for antioxidant therapy. J Acquir Immune Defic Syndr. 2002 Oct 1;31 Suppl 2:S84-8.
“Controlled for confounding variables, cocaine exposure [in infants via their mother] had significant effects on cognitive development, accounting for a 6-point deficit in Bayley Mental and Motor Scales of Infant Development scores at 2 years, with cocaine-exposed children twice as likely to have significant delay (mental development index <80) (odds ratio, 1.98; 95% confidence interval, 1.21-3.24; P =.006). For motor outcomes, there were no significant cocaine effects…The 13.7% rate of mental retardation is 4.89 times higher than expected in the population at larger…Cognitive delays could not be attributed to exposure to other drugs…poorer cognitive outcomes were related to higher amounts of cocaine metabolites in infant meconium as well as to maternal self-reported measures of amount and frequency of cocaine use during pregnancy, providing further support for a teratologic model. [note that many HIV-positive infants were exposed to cocaine in-utero and their ill health and problems may be blamed on HIV, not cocaine]
Singer LT et al. Cognitive and motor outcomes of cocaine-exposed infants. JAMA. 2002 Apr 17;287(15):1952-60.
[‘crack’ cocaine] produces a near-instantaneous euphoric effect…Because of this property and growning concern over the risks of HIV transmission by the IV route, smoking of crack cocaine has largely replaced other modes of recreational cocaine use…[The findings in this study] suggest that a high proportion of seeming healthy crack users have chronic alveolar [lung sac] hemorrhage [bleeding] that is clinically inapparent [i.e. coughing up blood was rarely observed]
Baldwin GC et al. Evidence of chronic damage to the pulmonary microcirculation in habitual users of alkaloidal ("crack") cocaine. Chest. 2002 Apr;121(4):1231-8.
“These findings suggest that a high proportion of seemingly healthy crack [cocaine] users have chronic alveolar hemorrhage [bleeding in the lung cavities where oxygen/carbon dioxide exchange takes place] that is clinically inapparent. In a larger sample of 202 healthy crack smokers from whom this volunteer sample was drawn, we previously noted a 6% prevalence of self-reported hemoptysis [coughing up blood]
Baldwin GC et al. Evidence of chronic damage to the pulmonary microcirculation in habitual users of alkaloidal ("crack") cocaine. Chest. 2002 Apr;121(4):1231-8.
“Multivariate analysis of the female participants’ practices revealed injecting cocaine once or more per day compared with injecting less than once per day [increased the risk by 2.6 times]…of time to HIV seroconversion. Among male participants, injecting cocaine once or more per day [increased the risk by 3.3 times]…of HIV infection.”
Spittal PM et al. Risk factors for elevated HIV incidence rates among female injection drug users in Vancouver. CMAJ. 2002 Apr 2;166(7):894-9.
“Of the 1911 subjects [attending a sexually transmitted disease clinic] who denied having high-risk behaviors (male homosexuality, intravenous drug use, or sexual contact with high-risk persons), crack cocaine and HIV infection were associated with an odds ratio of 10.6:1 for women and 3.3:1 for men. This relationship is supported by other epidemiologic studies and by reports suggesting that cocaine depresses the immune system both in vivo and in vitro [but, of course, cocaine can’t actually cause immune deficiency by itself, it can only be a lowly handmaiden to HIV, which is really responsible for all immune deficiency]
Roth MD et al. Cocaine Enhances Human Immunodeficiency Virus Replication in a Model of Severe Combined Immunodeficient Mice Implanted with Human Peripheral Blood Leukocytes. J Infect Dis. 2002 Mar 1;185(5):701-5.
“Use of cocaine (rather than heroin) was independently associated with HIV prevalence among men [IV drug users in Montreal]
Bruneau J et al. Sex-specific determinants of HIV infection among injection drug users in Montreal. CMAJ. 2001 Mar 20;164(6):767-73.
“The exact mechanisms by which cocaine facilitates this disease [AIDS] are yet to be proven, but likely include a combination of increased risk due to cocaine-related social behaviours, a wide-ranging capacity for cocaine to suppress the immune system, and an effect of cocaine on the infectivity and replication of HIV…both human and animal studies document that cocaine alters the function of natural killer (NK) cells, T cells, neutrophils and macrophages, and alters the ability of these cells to secrete immunoregulatory cytokines.”
Baldwin GC, Roth MD, Tashkin DP. Acute and chronic effects of cocaine on the immune system and the possible link to AIDS. J Neuroimmunol. 1998 Mar 15;83(1-2):133-8.
“Use of marijuana and cocaine is on the rise in the United States. Although pulmonary toxicity from these drugs has occasionally been reported, little is known about their effects on the lung microenvironment. We evaluated the function of alveolar macrophages (AMs) recovered from the lungs of nonsmokers and habitual smokers of either tobacco, marijuana, or crack cocaine…These findings indicate that habitual exposure of the lung to either marijuana or cocaine impairs the function and/or cytokine production of AMs. The ultimate outcome of these effects may be an enhanced susceptibility to infectious disease, cancer, and AIDS.”
Baldwin GC et al. Marijuana and cocaine impair alveolar macrophage function and cytokine production. Am J Respir Crit Care Med. 1997 Nov;156(5):1606-13.
“In the present study, we evaluated the capacity of cocaine to modify lymphocyte [white blood cells important in the immune system] cytokine production. Cocaine abrogated the IL[Inter-Leukin]-2-stimulated production of IFN-gamma and IL-8 by PBL [peripheral blood lymphocytes]…Both IL-8 and IFN-gamma are important mediators of the inflammatory response. A decrement in production of these cytokines by activated lymphocytes may significantly limit immune responses at multiple levels, resulting in an increased susceptibility to infection and malignancy.”
Mao JT et al. Cocaine down-regulates IL-2-induced peripheral blood lymphocyte IL-8 and IFN-gamma production. Cell Immunol. 1996 Sep 15;172(2):217-23.
“ROI [Reactive Oxygen Intermediates] and RNI [Reactive Nitrogen Intermediates] are highly reactive molecules, which kill most ingested extracellular or intracellular microbes. Thus both products provide strong protection from pathogens…we treated macrophages with different concentrations of cocaine for 45, 90 and 150 min. intervals. The results show that cocaine could inhibit the production of superoxide and hydrogen peroxide…This inhibition was correlated with the rate of ROI production”
Shen HM et al. Suppression of macrophage reactive intermediates by cocaine. Int J Immunopharmacol. 1995 May;17(5):419-23.
[Table 4 shows that regular crack users are 2.3 times more likely to be HIV+ than the entire group studied, the likelihood increases from no more likely with no more than 1 year smoking crack regularly to 2.1 times more likely with 6 or more years regular smoking, and to 4.7 times for those who participated in homosexual anal intercourse. The possibility that exposure to amyl nitrites, semen or crack could directly stimulate the production of antibodies is not even considered]
Edlin BR et al. Intersecting epidemics: crack cocaine use and HIV infection among inner-city young adults. N Engl J Med. 1994 Nov 24;331(21):1422-7.
“Cocaine is reported to be immunotoxic…Our experimental data confirm that exposure of normal human T cells to micromolar concentrations of cocaine modulates T-cell responses to stimulation by a variety of stimuli, and indicate that cocaine impairs early activation events during CD4+ but not CD4- T-cell stimulation…Our data support the proposition that cocaine abuse may place cocaine-abuser HIV-seropositive individuals at increased risk of opportunistic infections [but the experiments used blood cells from HIV-negative, healthy people, so presumably apply to people regardless of their HIV status]
Chiappelli F et al. Cocaine blunts human CD4+ cell activation. Immunopharmacology. 1994 Nov-Dec;28(3):233-40.
“The adjusted HR [hazard ratio] for seroconversion [becoming HIV-positive] associated with five or more sexual partners in the previous year was significantly elevated (HR=3.4 [i.e. 3.4 times higher than the average rate]). Current intravenous cocaine use (HR 2.5) and (marginally) crack [cocaine] use (HR=3.2) were associated with risk of seroconversion, but intravenous heroin and amphetamine use were not…Sharing needles and bleach use were not associated with seroconversion…When we examined the principal risk factors separately by sex, the HR associated with crack use, number of sexual partners and intravenous cocaine use were very large among female subjects”
Moss AR et al. HIV seroconversion in intravenous drug users in San Francisco, 1985-1990. AIDS. 1994 Feb;8(2):223-31.
“The biologic effects of substances of abuse, especially their modulation of the immune system, may significantly contribute to the outcome of an infection.”
Bagasra O, Pomerantz RJ. Human immunodeficiency virus type 1 replication in peripheral blood mononuclear cells in the presence of cocaine. J Infect Dis. 1993 Dec;168(5):1157-64.
“one third of the 43 women [from Florida] who had used crack cocaine were infected [HIV seropositive][and] were seven times more likely to be positive for gonorrhea and five times more likely to be positive for syphilis than those who reported never having used crack cocaine…the five independent predictors of HIV infection in these women were having used crack cocaine [3.3 times higher than those not in this group], having had more than two sexual partners [4.6 times], being black but neither Hispanic nor Haitian [11 times], having had sexual intercourse with a high-risk partner [5.6 times], and testing positive for syphilis in the prenatal examination [3.1 times]
Ellerbrock TV et al. Heterosexually transmitted human immunodeficiency virus infection among pregnant women in a rural Florida community. N Engl J Med. 1992 Dec 10;327(24):1704-9.
“The seroprevalence in [crack cocaine using] individuals denying [male-to-male sexual contact, intravenous drug use and heterosexual contact with an intravenous drug user] was 3.6% (50 out of 1389) and 4.2% (22 out of 522) in men and women, respectively.”
Chiasson MA et al. Heterosexual transmission of HIV-1 associated with the use of smokable free-base cocaine (crack). AIDS. 1991 Sep;5(9):1121-6.
“The HIV-1 seroprevalence of the study participants [patients at a STD clinic in the South Bronx] was 12% (369 out of 3084) and was the same for both men and women…Demographic characteristics, sexual and non-intravenous drug using behaviors were examined in more detail for the 50 seropositive men and the 22 seropositive women who denied traditional risk behavior for HIV-1 infection…13(59%) of the women were crack [smokable, freebase cocaine] users…Among the men, 24% reported crack use. The overall seroprevalence among the 201 crack users, who denied traditional HIV associated risk behaviors, was 12%”
Chiasson MA et al. Heterosexual transmission of HIV-1 associated with the use of smokable free-base cocaine (crack). AIDS. 1991 Sep;5(9):1121-6.
“The majority [23/36] of HIV-infected individuals denied usual risk factors for HIV…HIV infection was associated with female sex, crack cocaine use, GUD [genito-urinary disease] and multiple concurrent STDs.”
Chirgwin K et al. HIV infection, genital ulcer disease, and crack cocaine use among patients attending a clinic for sexually transmitted diseases. Am J Public Health. 1991;81(12):1576-9.
“the process [of ‘free-basing’ cocaine to inhale it] entails subjecting a white powder containing cocaine hydrochloride and other substances, ranging from lactose and procaine amid to cellulose and other poorly characterized solvents [often ether] and diluents, to a procedure by which the material is converted to an alkaloid form of cocaine…”free-base”.”
Lerner WD. Cocaine abuse and acquired immunodeficiency syndrome: a tale of two epidemics. Am J Med. 1989 Dec;87(6):661-3.
“Our experiments show that cocaine has a general suppressive effect on the mouse immune system…Injections of 5 mg/kg of cocaine 24hr before assay suppressed the number of thymocytes but the effect was not observed 48, 72, and 96 hr after injections. However, at higher doses, the suppressive effects on thymocytes were not entirely recovered 96 hr after injection…The size of two different tumors appeared to increase in cocaine-treated mice”
Ou DW, Shen ML, Luo YD. Effects of cocaine on the immune system of Balb/C mice. Clin Immunol Immunopathol. 1989 Aug;52(2):305-12.
[Subjects in this study were in public methadone treatment for heroin or cocaine addiction in 1986 and 1987] A strong association was found between [HIV] seropositivity and current or prior cocaine injection. The odds ratio for current monthly cocaine injection compared with no cocaine use was 2.2 and rose to 2.6 for weekly cocaine injection and to 6.4 for daily cocaine injection. Conversely, the frequency of current heroin injection was only weakly associated with HIV infection, with no increased risk for monthly use and only slightly increased risk for daily heroin injection compared with no current heroin use…no subject had regularly used cocaine prior to 1984…Intravenous cocaine use has increased dramatically in the last decade…cocaine injectors had a higher prevalence of HIV infection whether they used cocaine alone, cocaine and heroin separately, or cocaine and heroin mixed together.”
Chaisson RE et al. Cocaine use and HIV infection in intravenous drug users in San Francisco. JAMA. 1989 Jan 27;261(4):561-5.
“The interviews confirmed an association between intravenous drug use and HIV seropositivity [16/35 taking drugs only intravenously], surprisingly, however, the results also indicated a significant relation between non-intravenous use of cocaine and crack and seropositivity [84% taking cocaine and crack other than intravenously]
Sterk C. Cocaine and HIV seropositivity. Lancet. 1988 May 7;331(8593):1052-3.
“Patients [with Kaposi’s Sarcoma] reported significantly longer histories of ever having been exposed to chemicals or solvents at work (risk ratio = 7.5) [compared to matched patients without KS]...self-reports of ever having used various recreational drugs, including amyl nitrite, ethyl chloride, cocaine, phencyclidine (‘angel dust’), methaqualone, and amphetamines…[were each] associated with a risk ratio of 4 or greater [i.e. patients with KS were at least 4 times more likely to have used each of these drugs, than those without]...Significant dose-response relationships were found for amphetamines, amyl nitrite, cocaine, and ethyl chloride”
Marmor M et al. Risk factors for Kaposi’s Sarcoma in homosexual men. Lancet. 1982 May 15;1:1083-6.

© Copyright September 3, 2012 by Rethinking AIDS.