Slide 1: Question: Speedball use in AIDS is associated with which complication?

Slide 2: Answer: A fulminant and potentially fatal encephalopathy.

Slide 3: “Speedball,” a combination of cocaine and heroin, is used by those who wish to experience a synergistic high while hoping to mitigate side effects of each drug. Speedball use in patients with AIDS has been reported to precipitate a rapidly progressive dementia marked by seizures, high mortality (80% with a median survival of 21 days), and basal ganglia hyperintensities on T2/FLAIR.

Slide 4: In vitro studies have shown that opiates and cocaine both potentiate the gp120-induced apoptosis of neurons. As a reminder, gp120 is a protein that allows for HIV cell entry upon binding to CCR5 or CXCR4. Cocaine, a known vascular mediator, may also increase vascular permeability to other neurotoxins.


  • Newsome SD, Johnson E, Pardo C, McArthur JC, Nath A. Fulminant encephalopathy with basal ganglia hyperintensities in HIV-infected drug users. Neurology. 2011 Mar 1;76(9):787-94. PMID 21357830.
  • Hu S, Sheng WS, Lokensgard JR, Peterson PK. Morphine potentiates HIV-1 gp120-induced neuronal apoptosis. J Infect Dis. 2005 Mar 15;191(6):886-9. Epub 2005 Feb 10. PMID 15717263.
  • Turchan J, Anderson C, Hauser KF, et al. Estrogen protects against the synergistic toxicity by HIV proteins, methamphetamine and cocaine. BMC Neurosci. 2001;2:3. Epub 2001 Mar 2. PMID 11252157.