HIV-infected Intravenous Drug Users Research Articles

Immune Serum Markers and CD4 Cell Counts in HIV-Infected Intravenous Drug Users

We examined the association of three serum immune markers with CD4 cell counts in a large cohort of i.v. drug users with and without human immunodeficiency virus (HIV) infection. Levels of beta 2-microglobulin and neopterin were significantly elevated in HIV-infected subjects and increased in association with decline in CD4 cell counts (all p less than 0.001). Serum IgA levels in HIV-seropositive individuals were significantly elevated only when the CD4 cell count was less than 200/microliters (p less than 0.001). After controlling for HIV status and CD4 count, recent history of hepatitis was associated with significantly higher beta 2-microglobulin (p = 0.028) and marginally higher neopterin (p = 0.052) levels. There was no association of race, gender, or drug use patterns with levels of serum immune markers after controlling for HIV status and CD4 count. These data indicate that immune activation is coupled with immunosuppression in HIV-infected i.v. drug users. In addition, beta 2-microglobulin and neopterin levels are elevated in persons with a recent history of hepatitis but not in those with recent non-AIDS-defining bacterial infections. Markers of immune activation do not vary by race, gender, or drug use patterns among i.v. drug users.

Increasing morbidity without rise in non-AIDS mortality among HIV-infected intravenous drug users in Amsterdam.

We determined pneumonia, endocarditis, hospitalizations and death rates in a group of HIV-infected and non-infected IVDU recruited at low-threshold methadone programmes in Amsterdam, The Netherlands to examine the influence of HIV infection on morbidity and non-AIDS mortality in intravenous drug users (IVDU) without AIDS. A prospective epidemiologic study among HIV-infected and non-infected IVDU in Amsterdam. We analysed patients attending the Municipal Health Service of Amsterdam. The patient group consisted of 197 HIV-seropositive IVDU and 193 HIV-seronegative IVDU as controls. We analysed incidence rates per person-year of bacterial pneumonia; hospitalizations and non-AIDS mortality; and relative risks for HIV-infected IVDU compared to non-infected IVDU. The incidence of bacterial pneumonia rose from 0.1 in 1986 to 0.29 in 1989 in HIV-infected IVDU. The overall relative risk for this group was 4.0 (95% confidence interval, 1.7-9.7) compared with non-infected controls. HIV-infected IVDU were more frequently hospitalized for bacterial pneumonia than non-infected IVDU (50 versus 13%). In contrast, non-AIDS mortality rates remained stable for both HIV-infected and non-infected IVDU. HIV seropositivity was not found to be an independent risk factor for non-AIDS mortality. We found a high and rising incidence of bacterial pneumonia among HIV-infected IVDU in Amsterdam without any consequential rise in non-AIDS mortality. This contrasts with reports from studies conducted in New York City, New York, USA, where bacterial pneumonia-related mortality has been found to increase markedly, coincident with the AIDS epidemic. Early detection of bacterial pneumonia and easy access to both inpatient and outpatient medical care may be important factors in preventing early death due to common bacterial pathogens in IVDU without AIDS.

Hepatitis C infection in the health care setting. I. Low risk from parenteral exposure to blood of human immunodeficiency virus-infected patients.

Many patients with human immunodeficiency virus (HIV) infection have also been infected with hepatitis C virus (HCV). To understand better the epidemiology of HCV infection in the health care setting, HCV antibody testing was done for 125 health care workers who had experienced parenteral exposures to blood of HIV-infected patients and for 33 control health care workers without such exposures. Of the 158 health care workers studied, two (1.3%) had positive tests for HCV, both on the baseline serum sample obtained at parenteral exposure. For the 98 exposed, seronegative health care workers who were prospectively followed, no HCV seroconversions were observed over a time of 17.6 +/- 16.9 months. At least 64 of these 98 health care workers were exposed to blood of HIV-infected intravenous drug users, a group with an HCV seroprevalence rate in excess of 50% at our center in suburban New York City. We conclude that parenteral exposure to blood of HIV-infected patients in the health care setting is rarely associated with the development of hepatitis C infection.

Hepatitis C in HIV-Infected Intravenous Drug Users and Homosexual Men in Suburban New York City

To the Editor.— Abnormal liver function test results are common in patients infected with the human immunodeficiency virus (HIV), and, although they are likely to be multifactorial in origin, they are undoubtedly related to viral hepatitis in some of these patients. The recent discovery of a serological marker for the hepatitis C virus has greatly improved diagnostic accuracy for this form of hepatitis.1Hepatitis C virus infection may be an important cause of significant liver disease in certain HIV-infected patients and poses an additional concern for health care personnel with occupational exposure to blood. In European studies, hepatitis C coinfection rates in excess of 50% have been found for both HIV-infected hemophiliacs and intravenous drug users, with rates as high as 26% reported for HIV-infected homosexual men.2,3 Few data are available, however, on hepatitis C coinfection rates for HIV-infected patients in the United States. The results of hepatitis

Hepatitis C in HIV-infected intravenous drug users and homosexual men in suburban New York City

Hepatitis C in HIV-infected intravenous drug users and homosexual men in suburban New York City

HIV infection in 1990: Rapid spread in several developing countries and still insufficient preventive strategies

HIV is spreading rapidly in some developing countries. In only 2 years the estimated number of HIV infected prostitutes and intravenous drug users climbed from 100000 in Thailand. Professionals who follow the AIDS epidemic believe the spread of HIV among heterosexuals in India to be greater than that in Thailand. 20% of the prostitutes in 1 section of Bombay India have been infected with HIV. Further the HIV prevalence rate among adults in rural areas alone in Uganda and Tanzania stands at approximately 20%. Senegal used to be only endemic for HIV-2 but not HIV-1 is also present. 15% of adult males and almost 13% of adult females have already died from AIDS in Abidjan Cote dIvoire. Blood transfusions and contaminated needles have infected >1000 children in Romanian hospitals. Heterosexual transmission accounts for 60% of all worldwide HIV infections and may climb to 80% by 2000. WHO predicts that the number of HIV infected individuals worldwide will increase from 6-8 million (1990) to 15-20 million (2000). Even though there have been new modes of HIV transmission detected which are not epidemiologically important a small risk of infection still exists. For example 8 infants who acquired HIV infection in a hospital have infected their breast feeding mothers. 2 rugby players acquired HIV from a sports injury. Evidence shows that AZT prophylaxis does not always prevent HIV infection. HIV infection among homosexual men in some areas of the US is beginning to rise again despite educational campaigns after falling. Present preventive strategies have not been able to reduce HIV transmission. Research on animals indicate that development of a partially protective vaccine against HIV may be available by 2000.

HIV-related severe thrombocytopenia in intravenous drug users

Severe thrombocytopenia (TP) accounted for 5.3% of cases in a consecutive series of 380 HIV-infected intravenous drug users (IVDUs) at presentation. Forty-one of 53 subjects with severe TP showed haemorrhages and were treated as follows: ten were splenectomized, 17 were given high-dose intravenous immunoglobulins (HDIg), and 10 received anti-Rh(D) immunoglobulins (anti-Rh Ig). Splenectomy induced a complete clinical response in all cases: four out of 10 patients maintained platelet counts greater than 100 x 10(9)/l. HDlg gave a good clinical response in all patients, but eight out of 17 suffered haemorrhages during the follow-up and recall treatments were necessary. Six out of 10 patients treated with anti-Rh lg maintained platelet counts greater than 30 x 10(9)/l, but in two cases the treatment was interrupted because of severe haemolysis. No patient progressed to overt AIDS during the follow-up. Splenectomized patients in particular did not show adjunctive risks of worsening of the HIV-related clinical picture. A platelet kinetic study performed in 20 patients with severe HIV-related TP suggests a possible role for platelet sequestration in TP of HIV-infected IVDUs, in which a liver involvement is very frequent.

Clinical and immunological aspects of HIV infection in drug addicts

Intravenous drug users (IVDUs) account for more than 64% of the total AIDS cases in Italy. The IVDUs' seropositivity rate is >70% in Milan and >50% in the main cities of Italy. The first evidence of seropositivity in this population dates back to 1979. In a cohort study performed in Milan the rate of progression to overt AIDS among IVDUs was 6% in 3 years (1984–1987). At presentation, more than 75% of the subjects had CD4+ cell counts higher than 400/mm 3 (mean 631, median 528, mode 465). These values are significantly higher than those observed in the same population in New York, the only American city with HIV-infection spread comparable to that observed in Milan. The probability of having CD4+ cell counts lower than 400, 300, and 200/mm 3 in relation to the length of follow-up was, respectively, 50, 40, and 2% after 36 months from presentation. At the same end point, subjects presenting less than 400 CD4+ cells at entry had 30% probability of falling under 200 cell/mm 3. The pattern of CD4+ cells, as much as the low percentage of yearly progression to overt AIDS, is probably related to the recent, even if rapid, spread of infection among IVDUs in Italy. The clinical features of overt AIDS present some differences between IVDUs and other at-risk groups. Among U.S. IVDUs with AIDS, Kaposi's sarcoma is infrequent (2.9% vs 27.7% in homosexual men) while mycotic infections such as deep candidiasis and cryptococcosis are significantly more frequent. The same pattern has been observed in our case file in Milan: esophageal candidiasis represents the most frequent cause of diagnosis of overt AIDS. Mycotic infections, overall, are more frequent than in U.S. IVDUs. The increased rate of mycotic infections among IVDUs might be justified by altered functions of nonspecific immunity, such as PMNL killing and phagocytosis of Candida albicans spores, impaired in HIV-infected IVDUs, but generally normal in infected subjects belonging to the other at-risk groups.

Increased risk of bacterial pneumonia in HIV-infected intravenous drug users without AIDS.

Although patients with AIDS have been noted to be at risk for bacterial pneumonia as well as opportunistic infections, little is known about the risk of bacterial pneumonia in HIV-infected populations without AIDS. To determine the incidence of bacterial pneumonia in a well defined population of intravenous drug users (IVDUs), and to examine any association with HIV infection, we prospectively studied 433 IVDUs without AIDS, enrolled in a longitudinal study of HIV infection in an out-patient methadone maintenance program. At enrollment, 144 (33.3%) subjects were HIV-seropositive, 289 (66.7%) were seronegative. Over a 12-month period, 14 out of 144 (9.7%) seropositive subjects were hospitalized for community-acquired bacterial pneumonia, compared with six out of 289 (2.1%) seronegative subjects. The cumulative yearly incidence of bacterial pneumonia was 97 out of 1000 for seropositives and 21 out of 1000 for seronegatives (risk ratio = 4.7, P less than 0.001). Eleven out of 14 (78.6%) cases among the seropositive patients were due to either Streptococcus pneumoniae [5] or Hemophilus influenzae [6]. Two out of 14 (14.3%) cases among the seropositives were fatal. Stratifying by level of intravenous drug use indicated that even among subjects not reporting active intravenous drug use at study entry, eight out of 82 (9.8%) seropositives compared with three out of 211 (1.4%) seronegatives were hospitalized for bacterial pneumonia over the study period (risk ratio = 6.9, P less than 0.01). This study shows a markedly increased incidence of bacterial pneumonia associated with HIV infection in IVDUs without AIDS.(ABSTRACT TRUNCATED AT 250 WORDS)

Prostitutes: a high risk group for HIV infection?

Female prostitutes are at increased risk for sexually transmitted diseases and HIV infection. However, the prevalence rate of HIV infection among prostitutes varies geographically, with the highest rates occurring in Africa and in areas with large numbers of HIV infected intravenous drug users (IVDU). In Europe the most important risk factors for HIV infection in prostitutes are intravenous drug use and unprotected intercourse with non-paying partners. Whereas in Europe, there is as yet no evidence that female prostitutes are a source of HIV infection for the heterosexual population, they are playing a major role in the spread of HIV in Africa. Education about safe sex practices should be included in prevention programmes aimed at IVDUs. HIV infection should be monitored in prostitutes, and health education on AIDS prevention should be offered to prostitutes and their clients.

Peritoneoscopy. Endoscopic refinement par excellence.

<h3>OBJECTIVE:</h3> A sensitive and accurate dot blot assay using recombinant p24 (gag), gp41 and gp120 (env) proteins of HIV-1 and also recombinant gp36, the specific HIV-2 antigen was developed to confirm the presence of antibodies in sera reactive in screening enzyme-linked immunosorbent assays. <h3>METHODS:</h3> We collected sera from Iranian 125 confirmed HIV positive Iranian samples (seropositive group) from AIDS patients, asymptomatic HIV-infected subjects, HIV-infected intravenous drug users and also hemophilic infected subjects. The samples were obtained from the AIDS Specimen Bank, Pasture Institute, Iran during 2002 to 2003. We also obtained 180 samples (seronegative group) from healthy blood donors. Recombinant antigens were expressed in Escherichia coli. By use of highly purified antigens, the dot blot procedure was developed. Analysis of the results was accomplished by capturing the dot blot images. <h3>RESULTS:</h3> We established and interpreted the results using Centers for Disease Control criteria. We defined the positive test result as the presence of antibody against at least 2 different HIV gene products, one of which had to be an env gene product while a negative test result was defined as no antibodies against any of the HIV gene products and an indeterminate result was defined as antibodies reacting with only one HIV env gene product or against gag gene product only. <h3>CONCLUSION:</h3> The recombinant HIV dot blotting assay identified seropositive individuals with a high degree of accuracy; none of the HIV-seropositive subjects had a negative test result. Reactivity with these antigens, demonstrated 100% sensitivity and specificity in distinguishing seronegative from seropositive sera. The different sets of Western blot interpretative accepted criteria did not make a difference in interpretation of the seronegative and seropositive samples.