AIDS death rate
is higher among drug users

HIV patients who persistently use cocaine and heroin face a greater risk of opportunistic infections, disease progression, and death compared with HIV patients who do not use drugs, according to a new study.

Gregory M. Lucas of the Johns Hopkins University School of Medicine and colleagues used confidential computer-based interviews to survey patients in Baltimore at six-month intervals beginning in 1998. The study's 1,851 participants included 1,028 nonusers, 588 intermittent users (drug use for an average of 14 days in the previous six months), and 235 persistent users (drug use for an average of 27 days in the previous six months). At three years, the estimated survival rate was 68% for persistent users, 80% for intermittent users, and 87% for nonusers.

After the researchers adjusted for age, race, gender, lowest CD4-cell count, and highest HIV level, they found the risk of death was almost twice as high in intermittent users and close to three times as high in persistent users. During periods of abstinence from drug use, however, the risk of new opportunistic infections was near that of nonusers. When intermittent users were actively using drugs, their risk was closer to that of persistent users. The researchers noted similar risks for progression of HIV disease.

Lucas and colleagues suggested that the effects of drug use on disease progression may be related to increased viral replication, impaired lymphocyte function, reduced access to care, and poor adherence to drug therapy.

For patients who use heroin or cocaine, the authors recommended a treatment program that links HIV, substance abuse, and psychiatric treatment. Buprenorphine therapy for opioid dependence may help these patients, the researchers wrote. (Reuters)