Recreational drugs: relationship to AIDS.

Current data suggest that a transmissible agent causes AIDS, but undefined cofactors may also play a role. This paper reviews published data on the relationship between recreational drugs and immune alterations, with particular emphasis on nitrite inhalant (NI) use by homosexual men. In our original cohort of 15 homosexual men, helper:suppressor (H:S) T-cell ratios are stable, but persistently lower in the NI users. A recent analysis of 245 homosexual men shows that NI use is associated with low H:S ratios in homosexual men in Washington, D.C., but not in New York. Although NI use could increase the risk of AIDS by direct or indirect effects, it could also be a surrogate for a lifestyle practice that predisposes homosexual men to the putative AIDS agent. The current evidence concerning use of NI and the risk of AIDS is inconclusive, as is true for two other recreational drugs, heroin and cocaine. Future studies may not be able to dissect the complex interrelationships of drug use and other variables until precise laboratory tests are available for defining exposure to the putative AIDS agent and suspect cofactors.