Cocaine use appears to be connected to HIV reservoir size in study of US women

Cocaine use—both current and prior—was associated with HIV reservoir size among virally-suppressed women living with HIV, a U.S. study found. Results could inform cure research, as well as help explain an increased rate of HIV progression often seen in virally suppressed people who use cocaine.

About This Study

“Frequent Cocaine Use is Associated with Larger HIV Latent Reservoir Size” was published online on June 21, 2024, in Journal of Acquired Immune Deficiency Syndromes. The lead author is Bradley E. Aouizerat, Ph.D., of the Department of Oral and Maxillofacial Surgery and of the Translational Research Center, both at New York University in New York, New York.

Key Research Findings

Using a nested case-control study design, U.S. researchers measured intact HIV provirus in CD4 cells from 434 virally-suppressed women living with HIV, 160 of whom reported currently using cocaine and 59 of whom said they had previously used the substance. The amount of provirus indicates the size of the latent HIV reservoir in these immune cells.

Seventy-five percent of participants were Black, 14% were Latina, and 12% were white, and the average age was 47 years. The most recent mean CD4 cell count was 706 cells/µL. Current and prior cocaine users reported more cannabis use and more alcohol consumption as well, and had lower CD4 cell counts than non-users.

When measuring intact proviral DNA/10⁶ CD4 cells, the median HIV reservoir was 72 in the 215 women who had never used cocaine, 165 in prior users, and 184 in current cocaine users. A prior detectable viral load was associated with reservoir size across all three use groups, independent of cocaine use.

Discussion Highlights and Implications for Practice

Study limitations reported included the use of self-reported cocaine use, the fact that none of the assays that estimate HIV reservoir size can be considered 100% accurate, and the possibility that transient viremia between study visits affected results.

A prior study among men and women had found no association between cocaine use and HIV reservoir size. That study’s smaller sample size and inclusion of those with a history of injection drug use, as well as definitions of cocaine use, differed from this study.

Prior research showed that cocaine use is associated with faster HIV progression even in virally-suppressed people. Current results suggest that the substance keeps the replication-competent latent HIV reservoir larger than it would be otherwise. These findings could be important for cure research.

The current study was conducted among women because that population is not well represented in studies on the topic. Future research should evaluate the impact of hormones as well as cocaine on the viral reservoir.

By Barbara Jungwirth