Crack Cocaine Use Accelerates CD4 decline and is Associated With Poorer Nutritional Status in HIV+ Drug Users

Objective: To evaluate the effect of crack cocaine use on HIV disease progression and nutritional status. Methods: After consenting, 222 HIV+ drug users were followed for 30 mo. CD4 count, HIV viral load, anthropometries, 24‐hour intake recall, antiretroviral (ARV) treatment, and drug use was assessed every 6 months. Percent of adequate calorie and protein was determined using 3 dietary recalls taken over 12 months. Cox Regression was used to evaluate drug use and time to decline of CD4 to <200cells/μL. Results: Crack use was associated with a faster decline of CD4 to <200cells/μL (RR=2.027, CI: 1.024–4.013), after controlling for baseline CD4 and ARV use. Crack users had lower body mass index (logBMI: 1.38±0.08 vs. 1.40±0.08, p=0.044), greater likelihood of an albumin<4.0g/dL (p=0.032), and higher viral load (logVL: 4.21±1.02 vs 3.80±1.06, p=0.004). BMI and albumin were significantly correlated independent of viral load (r=0.142, p=0.035). Adequacy of energy and protein intake, monthly income, homelessness, food security, and ARVs were not different between crack users and non‐users. Conclusions: Crack use is associated with faster decline of CD4 count, and poorer nutritional status, despite similar energy and protein intake. Crack use may increase nutritional requirements, suggesting a need for specific nutritional intervention in crack users. Support: Funded by NIDA