Frequent Cocaine Use is Associated With Larger HIV Latent Reservoir Size

Abstract

Background: Cocaine-one of the most frequently abused illicit drugs among persons living with HIV [people living with HIV (PLWH)]-slows the decline of viral production after antiretroviral therapy and is associated with higher HIV viral load, more rapid HIV progression, and increased mortality.

Setting: We examined the impact of cocaine use on the CD4+ T-cell HIV latent reservoir (HLR) in virally suppressed PLWH participating in a national, longitudinal cohort study of the natural and treated history of HIV in the United States.

Methods: CD4+ T-cell genomic DNA from 434 women of diverse ancestry (ie, 75% Black, 14% Hispanic, 12% White) who self-reported cocaine use (ie, 160 cocaine users, 59 prior users, 215 non-users) was analyzed using the Intact Proviral HIV DNA Assay, measuring intact provirus per 106 CD4+ T cells.

Findings: HIV latent reservoir size differed by cocaine use (ie, median [interquartile range]: 72 [14-193] for never users, 165 [63-387] for prior users, 184 [28-502] for current users), which was statistically significantly larger in both prior (P = 0.023) and current (P = 0.001) cocaine users compared with never users.

Conclusions: Cocaine use may contribute to a larger replication competent HLR in CD4+ T cells among virologically suppressed women living with HIV. Our findings are important because women are underrepresented in HIV reservoir studies and in studies of the impact of cocaine use on outcomes among PLWH.

Figure 1.

Violin Plot of Intact CD4⁺ T-cell proviral HIV DNA by Cocaine Use Group The number of intact proviral DNA per million CD4⁺ T-cells was statistically significantly elevated in the Cocaine Use group (orange, n=160) as compared to the Cocaine Non-use group (blue, n=274). Cocaine use was defined as self-reported use of cocaine over the past six months. Generalized estimating equation Poisson regression model of the difference in intact proviral HIV DNA copies per million CD4⁺ T-cells in cocaine users as compared to non-users (p<0.001).

Figure 2.

Violin Plot of Intact CD4⁺ T-cell Proviral HIV DNA by Never Use, Prior Cocaine Use, and Current Cocaine Use Groups. The median and interquartile range for the number of intact proviral HIV genomes per million CD4⁺ T-cells for each group was 72 (median): (14, 193) median (interquartile range [IQR]) for never users, 165 (63, 387) for prior users (i.e., participants reporting not-currently cocaine using in the past six months but use of cocaine at some point in the past), and 184 (28, 502) for current cocaine users. Generalized estimating equation Poisson regression model of the difference in intact proviral HIV DNA copies per million CD4⁺ T-cells was statistically significantly elevated in the Current Cocaine Use group (orange, n=160, p<0.001), but not in the Prior Cocaine Use group (n=59, p=0.259) as compared to the Never Use group (blue, n=215).