Cocaine is an illegal stimulant drug that is made from the leaves of the South American coca shrub. It comes in the form of a white powder, which is usually snorted into the nose. It provides a short-lived feeling of excitement, exhilaration and self-confidence. 

Crack is a derivative of cocaine that is smoked.

With regular use, cocaine can cause anxiety, paranoia and a tolerance for the drug, meaning that larger doses have to be taken to achieve a similar high. Long-term use of cocaine can cause psychological dependence, anxiety, depression, psychosis, aggression, weight loss and malnutrition. It can also cause heart problems including heart attack, angina, irregular heartbeat, and inflammation and enlargement of the heart. 

Cocaine does not appear to interact with any anti-HIV drugs, as the drugs are metabolised through different pathways. 

Experiments conducted in HIV-infected mice found that mice exposed to cocaine had far fewer CD4 T-cells than mice not given the drug, more cells infected with HIV and higher viral loads, possibly through increasing the levels of HIV receptors on T-cells.1 Cocaine can also increase HIV replication in human cells in the test tube, suggesting that HIV disease may progress faster in regular cocaine users.2 However, this has not been observed in all studies of HIV-infected patients.3 

Animal and cell culture studies have also suggested that cocaine can increase the rates of nerve cell death in the brain and disrupt the blood-brain barrier, increasing the risk of HIV-related dementia.4 5 However, a study of cocaine users failed to find any additional impairment in neuropsychological function caused by the drug over that caused by HIV itself.6

Cocaine can also worsen or accelerate the hardening of the arteries that can occur with HIV infection or treatment, putting users at risk of heart attacks and strokes.7

As with other drugs of abuse, cocaine or crack use can impair adherence to HIV treatment.8


  1. Roth MD et al. Cocaine and sigma-1 receptors modulate HIV infection, chemokine receptors, and the HPA axis in the huPBL-SCID model. J Leukoc Biol 78: 1198-1203, 2005
  2. Peterson PK et al. Cocaine potentiates HIV-1 replication in human peripheral blood mononuclear cell cocultures. Involvement of transforming growth factor-beta. J Immunol 136: 81-84, 1991
  3. Larrat EP et al. Cocaine use and HIV disease progression among heterosexuals. Pharmacoepidemiol Drug Saf 5: 229-236, 1996
  4. Bagetta G et al. Inducible nitric oxide synthase is involved in the mechanisms of cocaine enhanced neuronal apoptosis induced by HIV-1 gp120 in the neocortex of rat. Neurosci Lett 356: 183-186, 2004
  5. Zhang L et al. Cocaine opens the blood-brain barrier to HIV-1 invasion. J Neurovirol 4: 619-626, 1998
  6. Durvasula RS et al. HIV-1, cocaine, and neuropsychological performance in African American men. J Int Neuropsychol Soc 6: 322-335, 2000
  7. Lai S et al. Human immunodeficiency virus 1 infection, cocaine, and coronary calcification. Arch Intern Med 165: 690-695, 2005
  8. Sharpe TT et al. Crack cocaine use and adherence to antiretroviral treatment among HIV-infected black women. J Community Health 29: 117-127, 2004

Community Consensus Statement on Access to HIV Treatment and its Use for Prevention

Together, we can make it happen

We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

Launched today, the Community Consensus Statement is a basic set of principles aimed at making sure that happens.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap

This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.