Substance Use, Cocaethylene and Obesity in HIV-Infected and Non-Infected Subjects from the Miami Adult Studies in HIV (MASH) Cohort (P10-082-19).

Abstract

Objectives\nCocaethylene (CE) is a blood metabolite indicating concomitant use of cocaine and alcohol. This combination increases the euphoric effects of cocaine, as well as its longevity in blood. Its toxicity is about 30% greater than that of cocaine or alcohol alone and has plasma half-life 3 to 5 times that of cocaine. CE has been associated with increased non-AIDS related morbidity and mortality, such as heart attacks, liver damage, and increased risk for immediate death. We examined polysubstance use, including the presence of CE and obesity in the MASH Cohort.\n\n\nMethods\nA subset of 74 HIV-infected and 75 non-infected participants (N\xa0=\xa0149) from the MASH Cohort were included for this analysis. Demographic characteristics and body mass index (BMI) were obtained through in-person interviews as part of the MASH Cohort s activities. Cocaine, alcohol and opioid use were determined by self-report (30-day use), urine toxicology and blood metabolites; AUDIT-C was also used for alcohol consumption.\n\n\nResults\nCocaine was used by 48.6% (n\xa0=\xa036) of HIV-infected and 52% (n\xa0=\xa039) of non-infected participants. CE was present in 28.6% (n\xa0=\xa08) of HIV-infected and 20.5% (n\xa0=\xa08) of non-infected participants; most were female (75.0%) and all were Black. BMI of those CE-positive was 35.4 kg/m2. Opioid use among CE-positive subjects was equal in both groups (62.5% each), but opioid use was more prevalent in HIV-infected than non-infected participants (68.9% vs. 54.7% respectively). CE concentrations were directly correlated with AUDIT-C and drinks/week (r\xa0=\xa0.313 and r\xa0=\xa0.391, respectively; P\xa0<\xa0.001). No differences in CE concentration and alcohol consumption were found between HIV-infected and non-infected participants. However, AUDIT-C was significantly higher among CE-positive subjects for both HIV-infected (µ\xa0=\xa03.5\xa0±\xa01.8 vs. 1.3\xa0±\xa01.6 for CE-positive and negative, respectively; P\xa0=\xa0.001) and non-infected participants (µ\xa0=\xa04.13\xa0±\xa02.9 vs. 1.91\xa0±\xa02.2 for CE-positive and negative, respectively; P\xa0=\xa0.01).\n\n\nConclusions\nBlood CE shows concurrent use of cocaine and alcohol. In addition, use of opioids and obesity is common among these MASH Cohort participants. Polysubstance use, in combination with obesity, may pose an increased risk for non-AIDS related morbidity and mortality. Longitudinal studies with larger samples are needed.\n\n\nFunding Sources\nNational Institute on Drug Abuse 5U01DA040381-03.