Drug intoxication and addiction can compromise judgment and decision-making and potentially lead to risky sexual behavior, including trading sex for drugs, and needle sharing. This increases a cocaine user’s risk for contracting infectious diseases such as HIV and hepatitis C (HCV).22 There are no vaccines to prevent HIV or HCV infections.
Studies that examine patterns of HIV infection and progression have demonstrated that cocaine use accelerates HIV infection.23 Research indicates that cocaine impairs immune cell function,24 promotes replication of the HIV virus, and potentiates the damaging effects of HIV on different types of cells in the brain and spinal cord, resulting in further damage.23 Studies also suggest that cocaine use accelerates the development of NeuroAIDS, neurological conditions associated with HIV infection. Symptoms of NeuroAIDS include memory loss, movement problems, and vision impairment.23
Cocaine users with HIV often have advanced progression of the disease, with increased viral load and accelerated decreases in CD4+ cell counts. Infection with HIV increases risk for co-infection with HCV, a virus that affects the liver.24 Co-infection can lead to serious illnesses—including problems with the immune system and neurologic conditions. Liver complications are very common, with many co-infected individuals dying of chronic liver disease and cancer.22 Although the link between injection drug use and HIV/HCV is well established, more studies are needed to understand the molecular mechanisms underlying this increased risk of co-infection in non-injecting substance users.24
The interaction of substance use, HIV, and hepatitis may accelerate disease progression. For example, HIV speeds the course of HCV infection by accelerating the progression of hepatitis-associated liver disease.24 Research has linked HIV/HCV co-infection with increased mortality when compared to either infection alone.24 Substance use and co-infection likely negatively influence HIV disease progression and the ability of the body to marshal an immune response.24
Patients with HIV/HCV co-infection can benefit from substance abuse treatment and antiretroviral therapies, when closely monitored.22 Antiretroviral treatment is not effective for everyone and can have significant side effects, necessitating close medical supervision. Testing for HIV and HCV is recommended for any individual who has ever injected drugs, since the disease is highly transmissible via injection.