HIV-infected Intravenous Drug Abusers Research Articles

Infective Endocarditis in Intravenous Drug Abusers.

Infective endocarditis (IE) is one of the most severe complications in intravenous drug abusers (IVDA). IE usually involves the tricuspid valve, Staphylococcus aureus is the most common etiologic agent, and it has a relatively good prognosis. Currently, between 40% and 90% of IVDA with IE are HIV infected, and the HIV epidemic has caused a decrease in the incidence of this disease, probably due to changes in drug administration habits undertaken by addicts in order to avoid HIV transmission. This review focuses on progress made over the past few years in some aspects of IE in IVDA. The pathogenesis of tricuspid endocarditis is still unknown more than 60 years after the first series. The most important advance in antibiotic therapy is that noncomplicated S. aureus right-sided endocarditis can be successfully treated with an intravenous 2-week course of nafcillin or cloxacillin plus an aminoglycoside, although probably the aminoglycoside administration could be stopped after the first 3 to 5 days. Surgery in HIV-infected IVDA with IE does not worsen the prognosis. Considering the possibility of reinfection in IVDA, prosthetic material is usually avoided. Tricuspid valvulectomy or valve repair should be considered the technique of choice in IVDA with right-sided IE. Replacement of the tricuspid valve by a cryopreserved mitral homograft is the latest introduction into clinical practice. It provides atrioventricular competence, thereby avoiding late right heart failure. Reinfections can be treated medically with a negligible reoperation rate. Overall mortality for HIV-infected or non-HIV-infected IVDA with IE is similar. However, among HIV-infected IVDA, mortality is significantly higher in those who are most severely immunosuppressed, with CD4(+) cell counts below 200/L or with AIDS criteria.

Pulmonary veno-occlusive disease in a HIV-infected intravenous drug abuser

Pulmonary veno-occlusive disease (PVOD) is a rare cause of pulmonary hypertension. Its origin remains unknown but in some cases a viral aetiology has been suggested. Recently primary pulmonary hypertension has been increasingly observed in patients with human immunodeficiency virus (HIV) infection, but only one case of pulmonary veno-occlusive disease has so far been described. We report the case of a 27 year old male intravenous drug abuser with HIV infection and pulmonary hypertension. Open lung biopsy led to the diagnosis of pulmonary veno-occlusive disease. This second case of pulmonary veno-occlusive disease raises the question of a relationship between HIV infection and lesions involving the pulmonary veins. However, the pathogenesis of vascular changes remains to be elucidated.

Somatic care wanted by HIV-infected intravenous drug abusers: the patients' opinions and experiences.

The somatic care of HIV-infected intravenous drug abusers (IVDUs) is often combined with many problems. The addict is often an unpopular patient, but society must assume responsibility for him or her and it is important to solve care problems in an appropriate way. This study was undertaken in order to investigate what kind of care addicts want when they become somatically ill. A questionnaire was given to patients who acquired HIV infection due to intravenous drug abuse, who visited an outpatient clinic for HIV-infected patients at the Department of Infectious Disease, Huddinge Hospital, Stockholm, Sweden. A total of 72 of the original 78 questionnaires could be evaluated. Thirty respondents took part in the Stockholm Methadone Programme. The patients were asked to rank the importance of professional competence among the staff. The patients ranked competence in pain treatment highest followed by competence in somatic medical care. Lower ranked, but still perceived as important, was competence in psychiatric medical care and social welfare work. Experience in treatment of addiction was ranked as less important. It can be concluded that it is fruitful to ask IVDUs about their preferences concerning care.

Rahnella aquatilis bacteremia in an HIV-infected intravenous drug abuser

Rahnella aquatilis, an unusual enteric Gram-negative rod, was isolated from three of four blood cultures of an HIV-infected intravenous drug abuser. The outcome was favorable after a 14-day course with ciprofloxacin. The identification of R. aquatilis isolates is discussed and a synopsis of the previously published antimicrobial susceptibility patterns of this microorganism is given.

CD8 +CD38 + and CD8 +DR + Peripheral Blood Lymphoid Subsets of HIV-Infected Intravenous Drug Abusers Correlate with CD4 + Cell Counts and Proliferation to Mitogens

Twenty-nine intravenous drug abusers (ivda), with asymptomatic HIV infection at entry, were sequentially studied at 4- to 6-month intervals for variable follow-up periods (mean, 19.6 months). Two of them progressed to AIDS and another one fell into the IV-C2 stage of the CDC classification at the end of the study. CD8 + lymphoid subsets (CD57 +, CD38 +, and HLA-DR +) were sequentially analyzed in peripheral blood samples along the follow-up. Both absolute number and percentage of cells within these subsets were found significantly increased over those observed in normal controls. Minor changes were appreciated throughout the follow-up CD8 +CD38 + and CD8 +DR + cells increased slightly ( P < 0.05), but the CD8 +CD57 + subset did not change significantly. In order to determine whether abnormalities in these subsets are associated with immune dysfunction, we looked for correlation between the quantification of CD8 + subpopulations and other parameters of cellular immunity. Percentage of CD8 +CD38 + or CD8 +DR + cells inversely correlates with absolute number of CD4 + cells ( P < 0.0001), and percentage of CD38 + subset also correlates with the proliferative response to mitogens in lymphoid cultures. Thus, the enumeration of these populations of CD8 + cells may provide some additional information about the immune status of HIV-infected ivda.

Isoniazid as Preventive Therapy in HIV-Infected Intravenous Drug Abusers

Tuberculin skin testing is a notoriously poor marker of tuberculosis infection in patients who are serologically positive for the human immunodeficiency virus. A decision analysis was performed to determine if and when isoniazid should be prescribed to prevent tuberculosis in these patients. The decision was analyzed for an intravenous drug abuser who may have been anergic, while tuberculin test status, race, and gender were varied. The assumptions and parameter estimates selected for this investigation represent a highly conservative vantage point opposing the use of isoniazid as a preventive therapy. Nevertheless, results showed a benefit from the use of isoniazid as a preventive therapy for all groups, even without tuberculin testing, except tuberculin-negative black women. This benefit of isoniazid therapy increased patient life expectancy as much as 285 days. Further, the decisions continue to favor prescribing isoniazid even when the suspected incidence of tuberculosis infection falls as low as 3% to 8%. Tuberculin testing appears important primarily for black women, since those who have negative tuberculin skin tests may not be candidates for isoniazid therapy.

Isoniazid as preventive therapy in HIV-infected intravenous drug abusers. A decision analysis

Tuberculin skin testing is a notoriously poor marker of tuberculosis infection in patients who are serologically positive for the human immunodeficiency virus. A decision analysis was performed to determine if and when isoniazid should be prescribed to prevent tuberculosis in these patients. The decision was analyzed for an intravenous drug abuser who may have been anergic, while tuberculin test status, race, and gender were varied. The assumptions and parameter estimates selected for this investigation represent a highly conservative vantage point opposing the use of isoniazid as a preventive therapy. Nevertheless, results showed a benefit from the use of isoniazid as a preventive therapy for all groups, even without tuberculin testing, except tuberculin-negative black women. This benefit of isoniazid therapy increased patient life expectancy as much as 285 days. Further, the decisions continue to favor prescribing isoniazid even when the suspected incidence of tuberculosis infection falls as low as 3% to 8%. Tuberculin testing appears important primarily for black women, since those who have negative tuberculin skin tests may not be candidates for isoniazid therapy. (<i>JAMA</i>. 1991;265:2987-2991)

Hodgkin's Disease in HIV-Infected Intravenous Drug Abusers

Hodgkin's Disease in HIV-Infected Intravenous Drug Abusers

Generalized Granuloma Annulare Located on Sun-Exposed Areas in a Human Immunodeficiency Virus—Seropositive Man With Ultraviolet B Photosensitivity

<h3>To the Editor.—</h3> Several cutaneous disorders have been observed in human immunodeficiency virus (HIV)-seropositive patients.¹Also, previously reported, albeit rarely, is the association of HIV infection and photosensitivity.^2,3We de Papules of granuloma annulare that appear in an annular configuration on the sun-exposed areas of the posterior aspect of the patient's neck. scribe a HIV-infected intravenous drug abuser with cryptococcosis who: (1) developed biopsy-confirmed cutaneous lesions of generalized granuloma annulare that were restricted to sun-exposed areas, and (2) demonstrated marked hypersensitivity to ultraviolet B (UVB) light. <h3>Report of a Case.—</h3> A 58-year-old Hispanic man who used intravenous drugs was found to be HIV seropositive in May 1987. He subsequently relocated from New York to Florida. Much of his time was occupied by sitting in the sun in a sleeveless V-necked undershirt. During this period, he began to develop a papular rash on the sun-exposed areas of his body.

Prevalence of oral lesions among HIV-infected intravenous drug abusers and other risk groups

To study the prevalence of oral manifestations, we examined 217 patients infected with the human immunodeficency virus (HIV). Most of our patients were intravenous drug abusers (IVDAs) (65%). Other risk categories were represented by IVDAs who were also male homosexuals or bisexuals (11%), male homosexuals and bisexuals (16%), sexual partners of HIV-infected patients (5%), and hemophilic persons and recipients of blood transfusions (3%). Forty-six patients were women and 171 were men, with a median age of 27 years (range, 11 to 65 years). At the time of first examination, 38% of patients had asymptomatic HIV infection, 36% had lymphadenopathy syndrome, 17% had AIDS-related complex, and 9% had AIDS. Oral manifestations were observed in 89 (41%) patients. Of these, 15 had asymptomatic infection, 23 had lymphadenopathy syndrome, 27 had AIDS-related complex, and 24 had AIDS. Increasing severity of disease was significantly associated with higher prevalence of oral lesions (p ≤ 0.0001). Candidiasis was the most common oral lesion, followed by hairy leukoplakia. Kaposi's sarcoma, melanotic macules, herpes labialis, condyloma acuminatum, perioral molluscum contagiosum, and bacterial glossitis due to Escherichia coli infection were found in a small number of patients. Results of culture for fungi, available for 203 patients, revealed that 51% of patients with positive Candida cultures had clinical evidence of candidiasis. Our study demonstrates that oral lesions are also important signs of HIV infection among IVDAs. Early diagnosis of these manifestations is becoming increasingly significant in the practice of dentistry.

Unusual malignant tumours in 49 patients with HIV infection

Between December 1986 and December 1988, the Italian Cooperative Group on AIDS-Related Tumours documented 49 HIV-related tumours other than malignant lymphomas (ML) and Kaposi's sarcomas (KS), predominantly among HIV-infected intravenous drug abusers (IVDA). Of 12 germinal testicular tumours collected, six were seminomas, two of which were pure embryonal and the other four embryonal mixed. Cervical carcinoma was observed in nine IVDAs (intraepithelial in eight and advanced, with rapid progression, in one). Lung cancer associated with HIV infection was reported in eight patients, of whom four had an adenocarcinoma, two a small cell carcinoma, one an epidermoid carcinoma and one a mesothelioma. All patients with non-small-cell-lung cancer (SCLC) were at stage III, while those with SCLC and mesothelioma had limited disease. Five out of eight presented with limited disease at onset. The median age was low; lung cancer occurred predominantly in young adults, of whom all but one were smokers. Three patients could not be treated; four died while on treatment because of progression of the neoplasia and one died of an overdose. Acute lymphoblastic leukaemia (ALL) was diagnosed in five patients. The immunophenotype was always Burkitt-like (L3), and acute myeloblastic leukaemia (M2) was diagnosed in one. Of the central nervous system (CNS) tumours, two cases of glioblastoma and one of medulloblastoma were described. Two cases of young adults with multiple myeloma and two cases of colorectal carcinoma were also reported. One case of chronic lymphocytic leukaemia, one anorectal carcinoma, one oral carcinoma, one pancreatic carcinoma, one thymoma, one kidney carcinoma, one malignant melanoma and thyroid carcinoma were also found.(ABSTRACT TRUNCATED AT 250 WORDS)