Treatment for cocaine addiction may reduce HIV risk

Cocaine addiction has previously been linked to an increased risk of contracting HIV, mainly as a result of sharing contaminated injection equipment, unprotected sex, exchange of sex for drugs, increased sexual drive from the stimulatory effects of cocaine, and impaired judgement. Although research has indicated that patients receiving treatment for heroin addiction have a decreased risk of HIV infection, few studies have focused on changes in HIV risk following treatment for cocaine addiction. Now, NIDA-funded researchers have found more evidence that participation in cocaine treatment may reduce the risk of HIV infection.

The researchers evaluated HIV risk among 487 cocaine-dependent patients that were recruited from five treatment programs participating in the NIDA Cocaine Collaborative Treatment Study. The multi-site trial examined the efficacy of four outpatient-based psychosocial treatments for cocaine dependence consisting of group drug counseling (GDC) alone and GDC in combination with individual drug counseling (IDC), cognitive therapy (CT), or supportive-expressive therapy (SE). Patients attended GDC weekly and individual therapy sessions for IDC, CT, or SE twice per week. At the end of screening and after 6 months of treatment, patients completed the Risk Assessment Battery, a standardized questionnaire that measures behaviors associated with HIV risk, such as drug use and high-risk sexual behaviors.

Prior to treatment, the average patient had used cocaine for 7 years and reported 10 days of cocaine use in the previous month. Crack smoking was the most common form of use. Seventy-nine percent of patients smoked crack, 19 percent snorted cocaine, and 2 percent injected the drug. HIV risk was mainly associated with high-risk sexual behaviors.

At the 6-month follow-up, cocaine use had decreased to an average of once per month. Patients receiving a combination of IDC and GDC showed the best improvements in reducing cocaine use compared to patients receiving CT and SE. Overall, the decrease in cocaine use was associated with a 40 percent reduction in HIV risk across all treatment, gender, and ethnic groups, mainly due to fewer sexual partners and less unprotected sex.

WHAT IT MEANS: These findings indicate that treatment for cocaine addiction, including HIV-risk-reduction counseling, may be an effective strategy for preventing HIV infection.

Dr. George E. Woody and colleagues from the University of Pennsylvania and the Department of Veterans Affairs Medical Center in Philadelphia published the study in the May issue of the Journal of Acquired Immune Deficiency Syndromes.

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