CMAJ • October 27, 2009; 181 (9). First published October 19, 2009; doi:10.1503/cmaj.082054
© 2009 Canadian Medical Association or its licensors
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Research

Smoking of crack cocaine as a risk factor for HIV infection among people who use injection drugs

Kora DeBeck, MPP, Thomas Kerr, PhD, Kathy Li, PhD, Benedikt Fischer, PhD, Jane Buxton, MD, Julio Montaner, MD and Evan Wood, MD PhD

From the British Columbia Centre for Excellence in HIV/AIDS (DeBeck, Kerr, Li, Montaner, Wood); the Division of AIDS, Department of Medicine (Kerr, Montaner, Wood), University of British Columbia; the Centre for Applied Research in Mental Health and Addictions (CARMHA), Faculty of Health Sciences (Fischer), Simon Fraser University; the School of Population and Public Health (Buxton), University of British Columbia, Vancouver, BC

Correspondence to: Dr. Evan Wood, BC Centre for Excellence in HIV/AIDS, 608–1081 Burrard St., Vancouver BC V6Z 1Y6; fax 604 806-9044; uhri-ew{at}cfenet.ubc.ca

Background: Little is known about the possible role that smoking crack cocaine has on the incidence of HIV infection. Given the increasing use of crack cocaine, we sought to examine whether use of this illicit drug has become a risk factor for HIV infection.

Methods: We included data from people participating in the Vancouver Injection Drug Users Study who reported injecting illicit drugs at least once in the month before enrolment, lived in the greater Vancouver area, were HIV-negative at enrolment and completed at least 1 follow-up study visit. To determine whether the risk of HIV seroconversion among daily smokers of crack cocaine changed over time, we used Cox proportional hazards regression and divided the study into 3 periods: May 1, 1996–Nov. 30, 1999 (period 1), Dec. 1, 1999–Nov. 30, 2002 (period 2), and Dec. 1, 2002–Dec. 30, 2005 (period 3).

Results: Overall, 1048 eligible injection drug users were included in our study. Of these, 137 acquired HIV infection during follow-up. The mean proportion of participants who reported daily smoking of crack cocaine increased from 11.6% in period 1 to 39.7% in period 3. After adjusting for potential confounders, we found that the risk of HIV seroconversion among participants who were daily smokers of crack cocaine increased over time (period 1: hazard ratio [HR] 1.03, 95% confidence interval [CI] 0.57–1.85; period 2: HR 1.68, 95% CI 1.01–2.80; and period 3: HR 2.74, 95% CI 1.06–7.11).

Interpretation: Smoking of crack cocaine was found to be an independent risk factor for HIV seroconversion among people who were injection drug users. This finding points to the urgent need for evidence-based public health initiatives targeted at people who smoke crack cocaine.


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