HIV as a surrogate marker for drug use: a re-analysis of the San Francisco Men's Health Study

Our analysis of drug use and morbidity data from a cohort of 1034 men yields the following results: 1) HIV infection is a strong indicator of drug use-HIV-positive respondents reported an average lifetime dose of recreational drugs (excluding marijuana) 2.3 times higher than HIV-negative respondents. 2) Homosexuality is a strong indicator of drug use-homosexual respondents reported an average lifetime dose 2.0 times higher than heterosexual respondents. 3) The incidence of AIDS-defining diseases was not limited to respondents infected with HIV, but was almost completely limited (98%) to respondents who reported using drugs. We also address a previous report (Ascher et al., 1993) that was based on the same database and purported to show that HIV alone correlates with the development of AIDS. Specifically, we show that the relationship between HIV infection and CD4+ T Cell loss is weaker than reported by Ascher et al., and provides little evidence for a causative relationship. These results support the hypothesis that long-term, habitual drug use can cause the conditions known as AIDS (independent of the presence of HIV), and refute the hypothesis that HIV alone causes these conditions independent of drug use.