Q and A


What are the risks of cocaine on CD4 counts for someone on HIV meds?

I would like to know if the recreational use of cocaine of 1 gram per week can have negative effects on the CD4 levels of a person in treatment for HIV with undetectable viral load (less than 20 copies/mL).

Is there a direct relation between immunity defences and cocaine recreational use?



Thanks for posting a question  and allowing us to post the answer online.

I wanted a couple of days to look into the research that might help. This is a long answer with lots as this is a subject where you have to decide your own risk. Hopefully, this will be helpful to other people as cocaine is widely used as a recreational drug.

I can’t answer your direct question easily because there are no studies of HIV-positve men on HAART who take a gram of coke a week compared to those who don’t. That is the study you need and it will never be done. So I’ve looked at your question from different perspectives:

• Does coke affect immune function?

• Does HIV and coke have a specific impact that is different to HIV-negative people?

• Does HAART use take away the HIV aspect of the risk?

• Are there other concerns relating to coke and health, in HIV-positive and HIV negative people?

• The question of the specific dose you asked about.

Firstly, cocaine does seem to have a direct link to reduced immune function. There is also data that shows that the interaction between cocaine and HIV has negative effects that are different (worse) compared to an HIV negative person.

These early studies, some, but not all, from pre-HAART reported links between cocaine use and reduced CD4 counts. In one study a similar link was not seen when heroin use was looked at.

Secondly, several studies support the view that cocaine has the potential to have a negative impact on immune function in the context of HIV that may be different to the impact in HIV-negative people.

These are just a few that I found easily. Most are pretty technical reports but they certainly don’t show cocaine to be harmless. Some hint at potential complications (including neurological disease, though not all). Cocaine use is difficult to study in a controlled way because research into recreational and street drug use is difficult to fund and ethically problematic. Where there are studies, these could easily underestimate harm as street cocaine may be very different to pure drug studied in a lab.

Short-term declines in CD4 levels associated with cocaine use in HIV-1 seropositive,  minority injecting drug users.

Cocaine blunts human CD4+ cell activation.

This next study in mice suggested that this might specific to HIV and cocaine. Sorry these are technical.

Cocaine Enhances Human Immunodeficiency Virus Replication in a Model of Severe Combined Immunodeficient Mice Implanted with Human Peripheral Blood Leukocytes

Effects of cocaine on the immune system of Balb/C mice.

Cocaine Differentially Modulates Chemokine Production by Mononuclear Cells from Normal Donors and Human Immunodeficiency Virus Type 1-Infected Patients

Proteomic analysis of the effects of cocaine on the enhancement of HIV-1 replication in normal human astrocytes (NHA)

HIV treatment, especially if your viral load is undetectable and your CD4 count is a good levels (above 500 is commonly referred to as ‘normal’) is pretty good at shutting down HIV and letting you get on with a normal life again. How this impacts risks when you knock it again with street drugs is difficult to define. Unfortunately, the concerns above seem to be as significant independently of whether you are on treatment.

Defining safe levels is also not easy. It seems reasonable to start from the likelihood that any use is harmful. In practice, an odd occasional line may have little measurable impact on your long term health. Clearly, you have been lucky so far. Coke is related to a fair percentage of hospital admissions, but clearly these are still only a small percentage of people who are using coke every week. You have to weigh up risks and benefits and think this is ok.

Taking a gram a week sounds a lot more than an occasional line. It is difficult to see how this level of use would not have some sort of risk to your health, both long-term and short-term.

A more significant worry probably relates to heart disease which has been reported with low and high doses, however taken, and in first time users and regular users (see NEJM link). It is implicated in a high number of hospital admissions for heart problems. The NEJM paper is pretty tough reading but includes mechanisms that increase the heart attack risks from cocaine and tobacco (not just the long term impact of smoking, but just smoking a cigarette at the same time) and the interaction between cocaine and alcohol. If the link needs a subscription, send me an email and I can send you the PDF file. If you want to use this much coke it is probably the most important study to read.

It is also commonly implicated in studies in HIV positive people.

Human Immunodeficiency Virus 1 Infection, Cocaine, and Coronary Calcification. [Download PDF of the full study].

Long-Term Cocaine Use and Antiretroviral Therapy Are Associated with Silent Coronary Artery Disease in African Americans with HIV Infection Who Have No Cardiovascular Symptoms

Illicit drug use and HIV treatment outcomes in a US cohort.

Cardiovascular Complications of Cocaine Use

Finally, many studies have reported that regular cocaine use is strongly related to poor adherence. Here is one but google can turn up lots more. I accept that this may not be relevant to you, and is more for other readers.

Impact of Active Drug Use on Antiretroviral Therapy Adherence and Viral Suppression in HIV-infected Drug Users

So, sorry for the longer than normal answer. Some other recreational drugs don’t have such serious risks. Smoking marijuana for example, has similar health risks to cigarettes (one study suggested these  might be higher) but doesn’t have the same impact on your immune sytem and your heart as cocaine.

I also accept that immune changes can be seen in lots of studies and these may or may not relate to a real difference in risk in the real world. There may be other studies that support minimal risk from occasional use, but I didn’t come across them when looking to answer these questions.

From a personal perspective, when you feel your heart on coke, it is beating like crazy. I now understand better that your body is sweating trying to pump blood, but the coke is shutting down and reducing the size of your blood vessels. Smoking and alcohol are also doing the same thing and making it worse. If you have other risk factors for heat disease, this seems likely to be a trigger each time you use it.

If you are already using a lot of coke this might take time to change slowly over time.

The research above may make this an aspect of your life that you want to look at.

Finally, chest pain is a symptom of heart problems. This has been reported from cocaine use not just soon after taking coke (within an hour) but also several hours later. Anyone getting chest pains after taking coke should seek urgent medical care.


  1. Lisa Thorley

    Hi Sherry,

    How long have you been on meds for? What meds are you taking? I’m asking as some ARVs could interact with the usage of cocaine.

    All class A’s have the potential to harm a person.

  2. Sherry

    Hi… I am hiv + and also I use cocaine maybe three times a month…. I have it under control and I take my meds every-day. My viral load is 965.
    Do u think I will harm myself?


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