Abstract
Cocaine has multiple and complex effects on cells infected with HIV1. Many of these effects appear to promote HIV1 infectivity and disease progression. Cocaine promotes virus replication in mononuclear phagocytes and, through its effects on IL10, tends to promote a Th2 cellular phenotype, which benefits CXCR4utilizing viruses. Cocaine can also upregulate the CCR5 receptor, and it acts synergistically with the toxic viral proteins Tat and gp120, exacerbating neuronal apoptosis. Additionally, cocaine exerts potent effects on microvascular permeability, thereby affecting the influx of virusinfected inflammatory cells into brain parenchyma. Epidemiological studies of drug abusers with AIDS link abuse of cocaine, even more than other drugs, to increased incidence of HIV seroprevalence and progression to AIDS. This chapter summarizes a wide range of cell culture and murine animal studies that have provided insight into the interactions of HIV1 and cocaine in the pathogenesis of HAND.