Effects of Alcohol and Crack Cocaine Use on Virological and Immunological Disease Progression in a C

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Effects of Alcohol and Crack Cocaine Use on
Virological and Immunological Disease Progression
in a Cohort of U.S. Women with HIV/AIDS

• Judith A. Cook, Ph.D.
• University of Illinois at Chicago
• Department of Psychiatry
• Presented at AIDS 2006 XVI International AIDS
  Conference
• Toronto, Canada
• August 15, 2006

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Collaborators

• Jane K. Burke-Miller
• Dennis D. Grey
• Mardge H. Cohen
• Robert Cook
• David Vlahav
• Farzana Kapadia
• Tracey Wilson

• Rebecca Schwartz
• Elizabeth Golub
• Kathy Anastos
• Claudia Ponath
• Lakshmi Goparaju
• Jean Richardson

Funded by U.S. National Institute of Allergy
Infectious Diseases National Institute on Drug
Abuse
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Study Background

• Heavy and at-risk alcohol use are associated with
  lesser likelihood of HAART use adherence (R.
  Cook et al., 2001 Samet et al., 2004)
• Crack/cocaine use is associated with lesser
  likelihood of HAART use adherence (J. Cook et
  al, 2006)
• Some evidence suggests that alcohol use
  crack/cocaine use are associated with faster HIV
  disease progression AIDS-related mortality
  (Samet et al., 2003 Farbris et al., 2000 J.
  Cook et al., 2002)
• Given the foregoing, do alcohol crack/cocaine
  use, together or separately, have an effect on
  disease progression that is independent of their
  effects on HAART use adherence?

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Direct or Indirect Effects of Alcohol Crack Use
on HIV Disease Progression?
At-Risk Alcohol Crack Use
?
?
?
Crack Use Alone
HIV Disease Progression
HAART Use Adherence
?
At-Risk Alcohol Use Alone
?
?
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Study Purpose

• To explore whether alcohol and crack/cocaine use,
  alone or in combination, are associated with
  HIV-positive womens virologic and immunologic
  disease progression

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Hypotheses

• Women using alcohol, crack/cocaine, or both have
  higher HIV RNA viral loads and negative CD4 cell
  count slopes over time.
• These effects are not modified by the influence
  of highly active antiretroviral therapy (HAART)
  use and adherence.

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Womens Interagency HIV Study (WIHS)

• Cohort study of HIV-positive women recruited in 6
  cities Chicago, Los Angeles, San Francisco,
  Bronx, Brooklyn, Washington, DC
• Data collection bi-annually beginning in 1994
  until present
• In-person interviews, physical exam, blood work,
  gynecological exam
• Data come from 1996 through 2002
• Funded by U.S. National Institute of Allergy
  Infectious Diseases National Institute on Drug
  Abuse

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Characteristics of WIHS Cohort Used in Analysis
(N1,691)

• African American 56
• Hispanic/Latina 24
• Caucasian 18
• Other 2
• High School Ed 63
• Average Age 37 years

• On HAART 68
• ARV Adherencegt95 66
• IDU 7
• Tobacco Use 56
• Income lt12,000/yr 62
• Probable depression 41
• Viral Load gt100,000 19
• CD4lt200 6

Current time
Study baseline
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Independent Dependent Variables

• Alcohol use measured by self-reported number of
  drinks per week (with 8 drinks per week defined
  as at-risk drinking per NIAAA guidelines)
• Crack use measured as any self-reported use in
  the past 6 months
• Plasma HIV-RNA copies categorized as gt100,000 vs.
  lt100,000
• CD4 slope calculated from biannual CD4 counts

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Control Variables

• study site
• time
• age
• race/ethnicity
• income
• education

• tobacco use
• injection drug use
• depressive symptoms
• CD4 as appropriate
• HIV RNA as appropriate

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Use of Alcohol and Crack/Cocaine at Baseline
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HIV RNA Viral Load Over Time by Use of
Crack/Cocaine At-Risk Drinking
Mean HIV RNA Viral Load
Study Visit (1994-2004)
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CD4 Over Time by Use of Crack/Cocaine At-Risk
Drinking
Mean CD4 Level
Study Visit (1994-2004)
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Effects of At-Risk Alcohol Crack Use on HAART
Use Adherencea

• Variable HAART USE
  ADHERENCE
• At-risk alcohol crack -0.64 -0.65
• At-risk alcohol alone -0.59 -0.60
• Crack alone -0.45 -0.58
• a Mixed effects logistic regression controlling
  for time, age, African American, Latina, income,
  education, tobacco use, IDU, depressive symptoms
• plt.05, plt.01, plt.001

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Effects of At-Risk Alcohol Crack Use on HIV RNA
Viral Load CD4 Slopea

• Variable HIV RNA Viral Loadb
  CD4c Slope
• At-risk alcohol crack 0.69 -0.09
• At-risk alcohol alone 0.28 -0.01ns
• Crack alone 0.10ns -0.04
• a Mixed effects regression controlling for
  time, age, African American, Latina, income,
  education, tobacco use, IDU, depressive symptoms
• b Controls for CD4lt200 c Controls for
  VLgt100,000
• plt.05, plt.01, plt.001, plt.10

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Effects of At-Risk Alcohol Crack on HIV Disease
Progression Controlling for HAART Use Adherencea

• Variable Viral Loadb CD4 Slopec
• At-risk alcohol crack 1.08 -0.13
• At-risk alcohol alone 0.20ns -0.06
• Crack alone 0.41ns -0.08
• HAART -2.29 -0.01ns
• Adherent -0.41 -0.03ns
• a Mixed effects regression controlling for
  time, age, African American, Latina, income,
  education, tobacco use, IDU, depressive symptoms
• b Controls for CD4lt200 c Controls for
  VLgt100,000
• plt.05, plt.01, plt.001, plt.10

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Conclusions

• HIV women engaging in at-risk alcohol use
  crack/cocaine use are at considerable risk of
  rapid virological immunological disease
  progression
• The effects of at-risk alcohol crack use are
  independent of HAART use adherence
• Alcohol crack use may affect disease
  progression through health behaviors (nutrition,
  exercise), psychological factors (depression,
  anxiety), HAART use adherence, or through
  direct biological effects