—We thank Dr Epstein for his interesting comment. It is true that use of cocaine, particularly crack cocaine, has been associated with HIV infection in several studies.1,2 However, our report noted that no individual drug was significantly associated with HIV infection. For cocaine specifically, there was no significant association between HIV infection and ever having used any type of cocaine (odds ratio [OR]=1.4; 95% confidence interval [CI], 0.4 to 4.7) or ever having used crack cocaine (OR=0.8; 95% CI, 0.4 to 1.7). However, the relatively small number of subjects who never used any type of cocaine (10%) or crack cocaine (18%) limits the power of these analyses, precluding a definitive conclusion. Similar studies in other populations may shed more light on the independent role of alcohol in HIV infection among polysubstance users. For example, Saxon and Calsyn3 recently reported that injection drug users who also used
Avins AL, Woods WJ, Lindan CP, Hudes ES, Clark W, Hulley SB. Cocaine and HIV Prevalence in an Alcohol Treatment Center-Reply. JAMA. 1994;272(6):435. doi:10.1001/jama.1994.03520060033024
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