Crack cocaine, disease progression, and mortality in a multicenter cohort of HIV-1 positive women


Use of crack cocaine by women with HIV/AIDS may make the disease progress faster in terms of low CD4 count, high viral load, illness, and death. To see if this is true in the WIHS, this study looked at the relationship of crack use in the WIHS to these four disease outcomes, from 1996-2004. Of the 1686 HIV+ women included in the study, almost a third reported crack use at some point over the 9 years (29% of the women). Most reported crack use at some but not all of their WIHS study visits, but 3% (54 women) reported crack use at all their visits. Women who reported persistent crack use (that is, use at all study visits) were over three times as likely as women who didn’t report crack at all to die from AIDS related causes, to have low CD4, and high viral load, even if taking HAART as prescribed, and regardless of age, race, income, education, and study site. Women who reported crack use at some or all of their study visits were more likely than non-users to develop new AIDS-defining illnesses. This study found that crack use does make HIV disease progress faster, although it doesn’t explain how. This suggests that women with HIV should be able to receive treatment for crack addiction along with their HIV medications and therapies. This may requre providers to do more follow-up with women who use crack, to be more understanding of their life situations, to help them toward quitting by focusing on positive things in their lives, and to arrange easy access to counseling.


Cook J, Burke-Miller J, Cohen M, Cook R, Vlahov D, Wilson T, Golub ET, Schwartz R, Howard A, Ponath C, Plankey M and Grey D. Crack cocaine, disease progression, and mortality in a multi-center cohort of HIV-1 positive women. AIDS 2008;22:1355-1363.