heroin and Acquired-Immunodeficiency-Syndrome

This paper on drug use and HIV/AIDS in China follows on from the column's May 2005 article on the description of the first methadone maintenance clinic in Beijing. Methadone maintenance clinics and needle exchange programmes are now being implemented in China as a response to the rapid increase in prevalence of HIV/AIDS over the last 10-15 years. It is worth noting that in prior years methadone was available only as for short-term detoxification from opioids and for research purposes. Accordingly, the Department of Health Education and Behavioural Intervention at the National Center for AIDS Prevention and Control in China plans to establish 1,000 methadone replacement clinics within the next 5 years to treat 200,000 heroin-dependent users who are at increased risk of HIV/AIDS. Robert Ali & Rachel HumeniukEditors, Asia Pacific ColumnThe cumulative number of registered drug users in mainland China increased from 70,000 in 1990 to 1.14 million in 2004. Heroin continues to be the most commonly used drug in China; however, polydrug use is popular among heroin users. Sedatives/hypnotics (e.g. triazolam) and other uncontrolled prescription opioids (e.g. pethidine and tramadol) are used commonly in combination with heroin. The majority of drug users (79%) are young people aged between 17 and 35 years and comprise predominantly farmers (30%) and unemployed people (45%). The HIV/AIDS epidemic in China has reached expansion phase (1995-present). It is estimated that the actual number of HIV/AIDS cases reached 840,000, including 80,000 actual AIDS patients, in 2003, with injecting drug users (IDUs) making up the largest proportion of these cases. Although the prevalence rate of HIV/AIDS is only 0.065% in the Chinese population overall, there is potential for an explosive spread of HIV/AIDS if preventative measures are not employed. Supported by the Chinese government and other related international organisations, harm reduction strategies such as methadone maintenance treatment (MMT) and needle-syringe programmes (NSP) have commenced implementation to reduce the risk of HIV infection among heroin users.

Topics: Acquired Immunodeficiency Syndrome; China; Harm Reduction; Heroin; Heroin Dependence; HIV Seropositivity; Humans; Methadone; Needle-Exchange Programs; Substance Abuse, Intravenous

Topics: Acquired Immunodeficiency Syndrome; Amphetamines; Animals; Borrelia Infections; Central Nervous System Diseases; Central Nervous System Neoplasms; Cocaine; Cytomegalovirus Infections; Heroin; Herpesviridae Infections; Humans; Lymphoma; Lymphomatoid Granulomatosis; Meningitis; Meningitis, Fungal; Mycoses; Neurosyphilis; Sympathomimetics; Vasculitis

Topics: Acquired Immunodeficiency Syndrome; beta-Endorphin; Cells, Cultured; Heroin; HIV-1; Humans; Interferon-gamma; Leukocytes, Mononuclear; Methadone; Morphine; Respiratory Burst; Substance Abuse, Intravenous; T-Lymphocytes; Virus Replication

Interim methadone maintenance has been proposed as a method of providing clinically effective services to heroin addicts waiting for treatment in standard comprehensive methadone maintenance programs.. A clinic that provided initial medical evaluation, methadone medication, and AIDS education, but did not include formal drug abuse counseling or other social support services was established in New York City. A sample of 301 volunteer subjects recruited from the waiting list for treatment in the Beth Israel methadone program were randomly assigned to immediate entry into the interim clinic or a control group.. There were no differences in initial levels of illicit drug use across the experimental and control groups. One-month urinalysis follow-up data showed a significant reduction in heroin use in the experimental group (from 63% positive at intake to 29% positive) with no change in the control group (62% to 60% positive). No significant change was observed in cocaine urinalyses (approximately 70% positive for both groups at intake and follow-up). A higher percentage of the experimental group were in treatment at 16-month follow-up (72% vs 56%).. Limited services interim methadone maintenance can reduce heroin use among persons awaiting entry into comprehensive treatment and increase the percentage entering treatment.

Topics: Acquired Immunodeficiency Syndrome; Adult; Female; Heroin; Heroin Dependence; Humans; Male; Methadone; New York City; Regression Analysis; Rehabilitation; Substance Abuse Treatment Centers; Substance Abuse, Intravenous

To investigate the impact of heroin for antiviral treatment, drug resistance, mutation types and frequency in HIV/AIDS patients in Guangxi Zhuang Autonomous Region.. HIV/AIDS patients were recruited in Methadone Maintenance Treatment Clinics, HIV/AIDS Clinic and HIV Voluntary Counseling and Testing Center Liuzhou and Baise city from April 2008 to October 2009. The patients were grouped by the situation of antiviral treatment and use of heroin. A total of 435 HIV/AIDS patients were recruited, among which 108 cases in antiviral treatment and heroin group, 93 cases in antiviral treatment and never using drug group, 105 cases in no antiviral treatment and using heroin group, 129 cases in no antiviral treatment and never using drug group. The effect of antiviral treatment was evaluated by questionnaire survey, viral load measurement and CD4(+) T lymphocyte count. HIV-1 RNA from plasma was extracted, and then the pol genes were amplified and sequenced. The sequences were analyzed for HIV-1 genotype drug-resistance.. For the patients who received antiviral treatment, the viral load in heroin group was higher than that in never using drug group (lg (2.61 ± 1.24) vs lg (2.08 ± 0.80), t = 3.54, P < 0.05) , and the percentage of viral load lower than 1 000 copies/ml in heroin group was significantly less than that in never using drug group (63.9% vs 86.0%,χ(2) = 12.76, P < 0.05). For the patients who received antiviral treatment, the difference has no significance in CD4(+) T lymphocyte count between heroin group and never using drug group ((337.92 ± 181.66) vs (326.14 ± 254.98), t = 0.38, P = 0.703). For the patients who didn't receive antiviral treatment, the difference also has no significance in CD4(+) T lymphocyte count between heroin group and never using drug group ((373.73 ± 155.97) vs (337.53 ± 209.26), t = 1.47, P = 0.143). For the patients who received antiviral treatment, there was no difference in the percentage of the CD4(+) T lymphocyte count more than 350/ml between heroin group and never using drug group (48.1% vs 43.0%, χ(2) = 0.53, P = 0.466). 319 HIV-1 pol gene sequences were obtained. Among the patients who received antiviral treatment, the mutation frequency of M184V/I, T215Y/F, L210W and T69N/S in heroin abuser group were significantly higher than that in never using drug group (14.9% (11/74) vs 4.4% (3/68), 12.2% (9/74) vs 1.5% (1/68), 12.2% (9/74) vs 1.5% (1/68) and 10.8% (8/74) vs 1.5% (1/68) respectively) (P < 0.05).. Using heroin may promote HIV replication, reducing the virological response to antiviral treatment and increasing the frequencies of drug resistance loci among HIV/AIDS patients.Heroin rehabilitation may benefit from the antiviral treatment and obtain better antiviral effect.

Topics: Acquired Immunodeficiency Syndrome; Anti-HIV Agents; Antiviral Agents; CD4 Lymphocyte Count; China; Drug Resistance; Drug Resistance, Viral; Genes, pol; Heroin; Heroin Dependence; HIV Infections; HIV-1; Humans; Mutation; Mutation Rate; Viral Load

The rapid increase in communication and transportation between Africa and other continents as well as the erosion of social fabric attended by poverty, ethnic conflicts, and civil wars has led to increased trafficking and consumption of illicit drugs. Cannabis dominates illicit trade and accounts for as much as 40% of global interdiction. Due to escalating seizures in recent years, the illicit trade in heroin and cocaine has become a concern that has quickly spread from West Africa to include Eastern and Southern Africa in the past 10 years. All regions of Africa are characterized by the use of cannabis, reflecting its entrenched status all over Africa. Most alarming though is the use of heroin, which is now being injected frequently and threatens to reverse the gain made in the prevention of HIV/AIDS. The prevalence of HIV infection and other blood-borne diseases among injection drug users is five to six times that among the general population, calling for urgent intervention among this group. Programs that aim to reduce the drug trafficking in Africa and needle syringe programs as well as medication-assisted treatment (MAT) of heroin dependence while still in their infancy in Africa show promise and need to be scaled up.

Topics: Acquired Immunodeficiency Syndrome; Africa; Cocaine; Epidemics; Heroin; HIV Infections; Humans; Illicit Drugs; Marijuana Abuse; Needle-Exchange Programs; Prevalence; Risk Factors; Substance Abuse, Intravenous

Strong opioids such as morphine are rarely accessible in low- and middle-income countries, even for patients with the most severe pain. The three cases reported here from three diverse countries provide examples of the terrible and unnecessary suffering that occurs everyday when this essential, inexpensive, and safe medication is not adequately accessible by patients in pain. The reasons for this lack of accessibility are explored, and ways to resolve the problem are proposed.

Topics: Acquired Immunodeficiency Syndrome; Adult; Analgesics, Opioid; Developing Countries; Dyspnea; Fatal Outcome; Female; Health Services Accessibility; Heroin; Humans; Male; Middle Aged; Morphine; Neoplasm Metastasis; Ovarian Neoplasms; Pain; Palliative Care; Patient Rights; Prostatic Neoplasms; Suicide; Terminally Ill

More than 93% of the nearly $500 million spent annually on Canada's drug strategy goes toward efforts to reduce the illicit drug supply. However, little is known about the effectiveness of this strategy. On Sept. 2, 2000, Canadian police seized approximately 100 kg of heroin in one of the nation's largest-ever seizures of this drug. An ongoing prospective cohort study of injection drug users afforded an opportunity to evaluate the impact of this seizure.. The Vancouver Injection Drug User Study is a prospective cohort study of injection drug users that began in 1996. The present study relied primarily on data acquired from participants who were seen during the 30-day periods immediately before and after the seizure. We compared drug use and behavioural characteristics, heroin and cocaine prices, and participants' reports of whether law enforcement had affected their source of drugs or the types of drugs available on the street, as well as overdoses, in these 2 periods.. The 138 participants seen before the seizure were similar to the 123 participants seen after the seizure with respect to age, sex, ethnic background, education, HIV serostatus, neighbourhood residence, instability of housing, employment status, use of methadone maintenance therapy and all other measured potential confounders (all p > 0.10). We found no difference in the extent to which participants in the 2 groups reported daily use of heroin, frequency of nonfatal overdoses, or whether law enforcement had affected their source of drugs or the types of drugs available on the street (all p > 0.10). Although we detected no difference in the price of cocaine, the median reported price of heroin went down after the seizure (p = 0.034), which suggests that other shipments compensated for the seizure. External evaluations of deaths from overdoses and heroin purity indicated that the seizure had no impact, nor was any impact seen when the periods of analysis were extended.. The massive heroin seizure appeared to have no measurable public health benefit. Closer scrutiny of enforcement efforts is warranted to ensure that resources are delivered to the most efficient and cost-effective public health programs.

Topics: Acquired Immunodeficiency Syndrome; British Columbia; Drug and Narcotic Control; Female; Heroin; Humans; Law Enforcement; Male; Substance-Related Disorders

Adherence is a primary determinant of treatment effectiveness; thus, poor adherence attenuates optimum clinical benefit. A bibliographic review was conducted to evaluate the impact of adherence to heroin dependence treatment on human immunodeficiency virus (HIV) transmission and to identify interventions proven to be effective in improving adherence. The best adherence rates were achieved by methadone and diacetylmorphine, both of which are comparable in promoting significant reduction in heroin use. Methadone adjusted-dose studies with daily doses ranging from 100 to 200 mg and multiple support interventions achieved the highest adherence rates. Studies of methadone maintenance that examined changes in HIV prevalence of infection have found that higher treatment adherence is correlated with a reduction in HIV transmission. These data suggest that patients who adhere continuously to methadone treatment are less likely to continue injecting illicit drugs and sharing contaminated injection equipment than are those who interrupt treatment, thus preventing the spread of HIV via drug injection.

Topics: Acquired Immunodeficiency Syndrome; Heroin; Heroin Dependence; HIV; HIV Seroprevalence; Humans; Methadone; Narcotics; Prevalence

Asian countries adjacent to the Golden Triangle and their neighbors have witnessed an evolution in "drug abuse" from traditional opium smoking to heroin eating, smoking, and finally heroin injection. A recent study of 630 heroin users was conducted in China's Yunnan Province, located close to the Golden Triangle. Data collected between August 1997 and February 1998 indicate injecting heroin users, in comparison to noninjectors, were more likely to have used drugs for a longer period of time, and to use drugs more frequently everyday. Other major differences existed between urban and rural subjects, especially highlighting differences between men and women. Women comprised a much higher proportion of urban subjects than rural subjects. Rural injectors were much more likely to be male, but urban injectors were almost evenly split between men and women. The emerging epidemic of heroin use in China and the continuing substance abuse problem in the United States provide an opportunity for collaborative research of mutual benefit.

Topics: Acquired Immunodeficiency Syndrome; Adult; Catchment Area, Health; China; Demography; Female; Heroin; HIV Seropositivity; Humans; Incidence; India; Male; Opioid-Related Disorders; Opium; Recurrence; Thailand

Since 1994-1995, rapid development of widely available substitution treatments has appeared to be a major healthcare step in heroin addiction. Currently approximately 60000 patients are taking daily maintenance doses of oral methadone and about 7200 are taking sublingual buprenorphine. In parallel with the expansion of these treatments, the number of lethal overdoses has fallen off regularly: 564 in 1994, 393 in 1996 and 143 in 1998 (-74.6% in 4 years).. We searched for a correlation between the rise in the number of patients taking maintenance treatments and the decreased in recorded deaths due to heroin overdose. Other factors which may influence this decrease were also considered.. A linear correlation was found between the increasing number of patients on maintenance treatment (high-dose buprenorphine or methadone) and the decrease in fatal heroin overdoses in France between 1994 and 1998. The importance of this correlation must be modulated by the presence of other events such as political, social, healthcare and behavioral events concerning drug users.

Topics: Acquired Immunodeficiency Syndrome; Attitude to Health; Buprenorphine; Drug Overdose; Drug Prescriptions; Drug Utilization; Female; France; Health Knowledge, Attitudes, Practice; Heroin; Heroin Dependence; Humans; Linear Models; Male; Methadone; Mortality; Narcotics; Population Surveillance; Risk Factors

To ascertain the causes of deaths among a very large cohort of heroin injecting drug users (IDUs) who, from 1985 to 1998, attended 36 Public Health Authority Centres for Drug Users (PCDUs) in north-eastern Italy.. Retrospective analysis of data, obtained from the Annual Register of each Centre and the Municipal Registry Office of each local health district.. Thirty-six PCDUs in north-eastern Italy and Medical Service for Addictive Disorders of the University of Verona.. All IDUs who had sought medical care at least once in the PCDUs during the study period.. Of 2708 deaths, overdose was found to be the major cause (37%), followed by AIDS (32.5%) and road accidents (9.4%). The percentage of deaths due to AIDS increased steadily from 2.7% in 1985 to 42.2% in 1996, and then decreased to 16.9% in 1998. Deaths due to overdose remained almost constant. The average age of death per year rose from 26 in the mid eighties to 34 in 1998. The mortality rate among IDUs proved much higher compared to the general population of the same age (13-fold, 95% CI, 11.3-14.6). The proportion of all deaths attributable to regular use of illegal opiates in the 15-34 age group in the general population in 1991 was 16%. HIV prevalence was not a significant factor in suicides and deaths by overdose.. The mortality rate was 13 times greater than in the general population. To be female and to have dropped out of any kind of treatment proved an important risk factor for overdose. The fall in deaths from AIDS enhances the problem to prevent and treat HCV infection. Decisions in drug projects, in research and in training should be influenced by the strikingly high percentage of deaths due to drug use.

Topics: Accidents, Traffic; Acquired Immunodeficiency Syndrome; Adolescent; Adult; Age Factors; Analysis of Variance; Cause of Death; Chi-Square Distribution; Drug Overdose; Female; Heroin; Humans; Incidence; Italy; Male; Patient Dropouts; Poisson Distribution; Registries; Retrospective Studies; Risk Factors; Sex Factors; Substance Abuse, Intravenous

Burma produces approximately 60% of the world's heroin, Laos is the third leading producer. Recent outbreaks of injecting drug use and HIV-1 in Burma, India, China, and Vietnam have been associated with Burmese and Laotian overland heroin trafficking routes. We analyzed findings from narcotics investigations, molecular epidemiology studies of HIV-1, and epidemiologic and behavioral studies of injecting drug use, to evaluate the roles that the heroin export routes play in the spread of drug use and HIV-1 in south and south-east Asia.. We reviewed the medical and narcotics literature, the molecular epidemiology of HIV, and did key informant interviews in India, China, and Burma with injecting drug users, drug traffickers, public health staff, and narcotics control personnel.. Four recent outbreaks of HIV-1 among injecting drug users appear linked to trafficking routes. Route 1: From Burma's eastern border to China's Yunnan Province, with initial spread of HIV-1 subtype B, and later C. Route 2: Eastern Burma to Yunnan, going north and west, to Xinjiang Province, with B, C, and a B/C recombinant subtype. Route 3: Burma and Laos, through northern Vietnam, to China's Guangxi Province, subtype E. Route 4: Western Burma, across the Burma-India border to Manipur, predominant subtype C, and B and E.. Overland heroin export routes have been associated with dual epidemics of injecting drug use and HIV infection in three Asian countries and along four routes. Molecular epidemiology is useful for mapping heroin routes. Single country narcotics and HIV programs are unlikely to succeed unless the regional narcotic-based economy is addressed.

Topics: Acquired Immunodeficiency Syndrome; Asia; Female; Geography; Government Agencies; Heroin; HIV-1; Humans; Interviews as Topic; Male; Narcotics; National Health Programs; Organizations; Substance Abuse, Intravenous

Topics: Acquired Immunodeficiency Syndrome; Adult; Heroin; Humans; Male; Massachusetts; Needle-Exchange Programs; Nursing Care; Pneumonia, Pneumocystis; Substance Abuse, Intravenous

To measure the current prevalence of different routes of heroin administration among users and to describe the most frequent patterns in the evolution of the main route from the time of first use to the present and their implications for the control of the HIV epidemic.. Cross-sectional study. Face-to-face interviews using a structured questionnaire.. Nine hundred and nine regular heroin users from Madrid, Barcelona and Seville (about 300 per city), half of them recruited in treatment centres and the other half out of treatment.. Socio-demographic characteristics, current and historical behaviours related to route of administration.. Before 1980 injection was the first main route of heroin administration for most users in Barcelona and Madrid; in Seville smoking already predominated, although 40% of users began by injecting. Sniffing subsequently became predominant in Barcelona, while smoking became the predominant first route in Madrid and Seville (smoking has been the only first route in Seville since 1991). The prevalence of injection as the main route of administration during the last 30 days was 77.3% in Barcelona, 24.3% in Madrid and 23.9% in Seville; smoking predominated in the latter two cities. The factors most strongly associated with injection as the preferred route were city of recruitment and having a partner who injected. Some 73% of those who stopped injecting in their last change of route stated that the results of their HIV test or fear of becoming infected had been important in making this decision.. The change from injecting to smoking will greatly facilitate the control of HIV infection in Spain. However, the main causal factor does not appear to be the perception of HIV risk, but rather other, ecological factors (cultural or market-related). The absence of these factors in some areas may impede the spread of smoking.

Topics: Acquired Immunodeficiency Syndrome; Adult; Cross-Sectional Studies; Fear; Female; Heroin; Humans; Male; Prevalence; Smoking; Spain; Substance Abuse, Intravenous; Substance-Related Disorders

Social influence processes have been found to affect numerous drug and health-related behaviors. We postulated that by using a network-oriented intervention it may be possible to capitalize on social influence processes to reduce human immunodeficiency virus (HIV) risk behaviors. The present study used an experimental study design for delivering a psychoeducational acquired immunodeficiency syndrome (AIDS) preventive intervention to injection drug sharing networks. Participants were recruited from the ALIVE study, an epidemiological study in Baltimore. In the present paper we examine the self-reported behavioral outcomes of 117 injection drug users 18 months after the baseline interview. HIV seronegative experimental participants reported significantly less frequent needle sharing and less injecting of heroin and cocaine than controls. In multiple logistic regression models of HIV seronegative participants, there was a significant negative association between assignment to the experimental group and the HIV-related behaviors of needle sharing and sharing of cookers in the prior 6 months; controls were 2.8 times more likely than experimentals to report needle sharing and were 2.7 times more likely to report sharing cookers. The results of this 18-month follow-up suggest that among injection drug users network-oriented interventions may be a promising approach to HIV prevention.

Topics: Acquired Immunodeficiency Syndrome; Adult; Cocaine; Female; Follow-Up Studies; Health Promotion; Heroin; HIV Seropositivity; Humans; Male; Patient Selection; Substance Abuse, Intravenous

The general public, police, service providers, and users/ex-users were asked their views about options for trial design and trial outcomes with regard to a proposal for experimental controlled heroin availability. There was substantial agreement between the samples on issues concerning trial design. In general, the samples from the community, service providers and users/ex-users were more likely to report that a trial would result in positive outcomes, whereas the police sample was more likely to report that a trial would result in negative outcomes. This study illustrates the value of systematic consultation of key groups in exploring the options for change, raising potential difficulties, and highlighting different interests.

Topics: Acquired Immunodeficiency Syndrome; Australia; Crime; Drug and Narcotic Control; Drug Prescriptions; Feasibility Studies; Heroin; Heroin Dependence; Humans; Life Style; Public Opinion; Social Problems; Substance Abuse, Intravenous; Treatment Outcome; Violence

Topics: Acquired Immunodeficiency Syndrome; Adult; Bacillus cereus; Bacteremia; Heroin; Humans; Male; Substance Abuse, Intravenous

Topics: Acquired Immunodeficiency Syndrome; Heroin; Humans; Methadone; Substance Abuse, Intravenous

Twenty-five HIV-seropositive drug abusers (DA+HIV+) (groups II-III and IV [A, C2 and E] of the CDC classification) were evaluated by use of the WAIS scale to determine any possible involvement of cognitive functions in the not yet overt phases of AIDS. The results were compared with those obtained in two control populations composed of 19 seronegative drug abusers (DA+HIV-) and 24 healthy subjects (DA-HIV-) to evaluate, in addition to the disease, the possible effect of the use of alcohol and toxic substances on cognitive performance. In spite of the small number of subjects, the study indicated that drug abuse is the main factor, among those analyzed, in determining a decline in cognitive functions.

Topics: Acquired Immunodeficiency Syndrome; Adult; Brain; Cognition Disorders; Dementia; Ethanol; Female; Heroin; HIV Seropositivity; HIV-1; Humans; Italy; Male; Risk Factors; Severity of Illness Index; Substance Abuse, Intravenous; Substance-Related Disorders; Task Performance and Analysis; Wechsler Scales

A survey was undertaken in Sydney in 1989 to identify factors associated with behaviour involving risk for human immunodeficiency virus infection. Self-report data on needle-sharing and sexual practices were collected from 91 heroin users entering a residential, drug-free detoxification unit. Data were analysed using polytomous and ordinal logistic regressions. Heroin-dependent subjects who also had a current alcohol problem were significantly more likely than others to report high risk needle-sharing behaviour. Subjects with more than one sexual partner in the last three months were significantly more likely to use condoms while those with a current benzodiazepine problem were significantly less likely to use condoms. Qualitative data suggest that high risk needle-sharing behaviour most often occurred around the time of relapse to injecting drug use and among homeless drug users occupying derelict buildings in inner-city suburbs.

Topics: Acquired Immunodeficiency Syndrome; Alcoholism; Benzodiazepines; Female; Heroin; Humans; Male; Needle Sharing; New South Wales; Risk-Taking; Sexual Behavior; Substance Abuse, Intravenous; Substance-Related Disorders

From 1987 through 1991, 2687 intravenous drug users recruited at three AIDS information centres in the Region of Valencia (Spain) were interviewed about drug use and sexual behaviour and subsequently tested for HIV-1 antibody. The overall seroprevalence was high, 50% (95% confidence interval [CI]: 41.8-51.9%). There were no differences by gender, but HIV-1 infection was related to older age and city of residence. After adjustment by means of logistic regression age (odds ratio [OR] = 1.80), sharing of injection equipment (OR = 2.16), duration of addiction (OR = 6.59) and prostitution (OR = 1.77) were significantly associated with HIV-1 prevalence. High educational level was inversely related to HIV-1 status (OR = 0.43) and a decreasing trend of prevalence with time was observed.

Topics: Acquired Immunodeficiency Syndrome; Adolescent; Adult; Female; Heroin; HIV Seropositivity; HIV-1; Humans; Interviews as Topic; Male; Needle Sharing; Sexual Behavior; Socioeconomic Factors; Spain; Substance Abuse, Intravenous; Time Factors

We used data from different sources to estimate the extent and the trend of the epidemic of drug use in Italy in the second half of the '80s. During the study period, the number of subjects attending drug dependency units increased from 13,905 to 61,689. Mortality and morbidity indicators showed an increase in both drug related deaths (mainly from overdose) and AIDS cases reported in injecting drug users, particularly among older subjects. However, the number of young adults detected as drug users at the army recruitment remained virtually stable from 1986 on. These findings suggest that both demand and availability of treatment increased through the years 1985-89, and that clinical consequences of drug use related behaviour have become an important public health priority.

Topics: Acquired Immunodeficiency Syndrome; Adolescent; Adult; Delivery of Health Care; Drug Overdose; Female; Health Promotion; Heroin; Humans; Italy; Male; Methadone; Middle Aged; Public Health; Substance-Related Disorders; Surveys and Questionnaires

Topics: Acquired Immunodeficiency Syndrome; Administration, Inhalation; Adolescent; Adult; Female; Heroin; Heroin Dependence; Humans; Injections; Male; Middle Aged

A cross-sectional seroepidemiologic study was carried out between 1985 and 1990 in 1,567 heterosexual intravenous drug users who had been seen at the AIDS Regional Reference Center in Palermo, Italy, to evaluate the rate of human immunodeficiency virus type 1 (HIV-1) seroprevalence in this group and its long-term trend. Sixty serum samples collected from drug users in 1980 and 1983, before the founding of the Center (1985), were tested as well. Some demographic and behavioral risk factors were studied in a subgroup of intravenous drug users enrolled in 1985, 1987, and 1990 for their possible association with HIV-1. These factors were also studied in relation to hepatitis B virus infection, since both viruses share the same modes of spread. These drug users had a higher prevalence of markers for hepatitis B virus than of HIV-1 antibodies, and the prevalence rates in sera collected declined over time for both infections. The presence of both antibodies to HIV-1 and markers for hepatitis B virus was independently associated with the age of the drug user, the duration of drug use, and the year of serum collection. Antibodies to HIV-1 were observed more frequently in females than in males. No relation was found between education or employment status and the presence of HIV-1 antibodies or hepatitis B virus markers. Although new HIV-1 infections still occur, the decline in seroprevalence observed at the end of the 1980s might be related to modifications in social behavior among newer drug users, partial exhaustion of the susceptible population, and increasing risk awareness in more experienced users.

Topics: Acquired Immunodeficiency Syndrome; Adolescent; Adult; Chi-Square Distribution; Cross-Sectional Studies; Female; Hepatitis B Antibodies; Hepatitis B Surface Antigens; Heroin; HIV Antibodies; HIV Infections; HIV Seroprevalence; HIV-1; Humans; Incidence; Italy; Logistic Models; Male; Multivariate Analysis; Odds Ratio; Prevalence; Risk Factors; Substance Abuse, Intravenous; Time Factors

Topics: Acquired Immunodeficiency Syndrome; Heroin; Heroin Dependence; Humans; Methadone; New York City; Rehabilitation; Substance Abuse Treatment Centers; Substance Abuse, Intravenous

From June 1986 to March 1990, a prospective seroprevalence survey and questionnaire of individuals at risk for HIV infection was conducted with volunteers in Winnipeg. Of 610 individuals enrolled, 146 were injected drug users (IDU). Fifteen IDU were in a methadone treatment program and all were seronegative. Three of 131 remaining IDU were HIV-1 seropositive (2.3%), a rate similar to 2.2% positive (20+ of 927) in diagnostic specimens from IDU tested in the province. Demographics and behaviour of 131 IDU were compared with 335 individuals, of whom 112 were gay/bisexual [24 of whom also had sexually transmitted diseases (STD)] and 223 heterosexuals who had STD. Males enrolled were significantly older than females. Multivariate analysis showed that factors independently associated with IDU were: a younger age, less education, mental health counselling, unemployment, and a history of jaundice or hepatitis. Drugs most commonly used were Ritalin/Talwin, cocaine, and heroin. Over 90% of individuals admitted to sharing needles. In spite of the low seroprevalence of HIV-1 infections, these individuals are important for the potential spread of HIV because of multiple means of acquiring and transmitting HIV and a high rate of needle sharing.

Topics: Acquired Immunodeficiency Syndrome; Adult; Cocaine; Female; Heroin; HIV Seropositivity; HIV Seroprevalence; Homosexuality; Humans; Male; Manitoba; Needle Sharing; Prospective Studies; Risk Factors; Sexually Transmitted Diseases; Substance Abuse, Intravenous; Surveys and Questionnaires

India is considered to have a low incidence of HIV infection so far. Nevertheless, an epidemic of HIV infection has been reported recently among intra-venous drug users (IVDUs) in Manipur, a north-eastern state of India, bordering Myanmar (Burma). This report describes the epidemiology of intravenous drug abuse in the state of Manipur. Four hundred and fifty IVDUs were interviewed. Their age (median 24 years) and sex patterns (95% male) differ from those reported from western countries. It is estimated that there may be approximately 15,000 such addicts in a population of 1.8 million and 50% of them could be positive for HIV. Knowledge of AIDS and its transmission is significantly higher among the addicts than non-addict controls. Free availability of heroin was found to be the major factor responsible for the high rate of addiction. It is presumed that two other neighbouring States which are well-connected to Manipur and also have a common border with Myanmar (part of the 'Golden Triangle') may have a similar problem with HIV infection.

Topics: Acquired Immunodeficiency Syndrome; Adolescent; Adult; Child; Female; Health Knowledge, Attitudes, Practice; Heroin; HIV Infections; Humans; India; Male; Middle Aged; Needle Sharing; Risk Factors; Sexual Behavior; Socioeconomic Factors; Substance Abuse, Intravenous

Topics: Acquired Immunodeficiency Syndrome; Heroin; Humans; Male; Substance-Related Disorders

Preventing illicit drug injection would be the ideal point for preventing HIV infection and AIDS among illicit drug injectors. This paper reports on clinical issues that arose in a program for intranasal ("sniffer") heroin users who were at high risk of injecting drugs. Extensive field notes were kept by the staff of the project. A generalized mistrust of authorities, denial of problems associated with non-injected drug use, and ambivalence about injecting were the major issues that arose during subject recruitment and the group sessions. The staff underwent trial and error learning, both becoming more confident in working with heroin sniffers, and finding better results for later participants in the study.

Topics: Acquired Immunodeficiency Syndrome; Administration, Inhalation; Adolescent; Adult; Attitude to Health; Curriculum; Female; Heroin; Heroin Dependence; Humans; Male; Patient Education as Topic; Pilot Projects; Risk Factors; Substance Abuse, Intravenous

An HIV study initiated in January 1987 is being conducted at the Remand Prison in Stockholm, Sweden, in order to follow HIV seroprevalence and HIV risk behaviour among intravenous drug users (IVDUs) in Stockholm. Up to December 1988 1152 arrested and detained IVDUs were interviewed about risk behaviour and tested for HIV antibodies. Amphetamine, which is the main IVDUs drug used intravenously in Stockholm, was used by 958 of these, while heroin was used by 194. HIV seroprevalence was 12.6%: 5.9% among the amphetamine and 45.5% among the heroin users. The HIV incidence was calculated to be 0.9% in 1987 and 1.2% in 1988, higher for amphetamine than for heroin users. Some risk reduction was reported regarding needle sharing, but less so regarding sexual behaviour.

Topics: Acquired Immunodeficiency Syndrome; Adult; Amphetamine; Behavior; Female; Heroin; HIV Seroprevalence; Humans; Male; Prisoners; Risk Factors; Sexual Behavior; Substance Abuse, Intravenous; Sweden; Time Factors

Topics: Acquired Immunodeficiency Syndrome; Administration, Intranasal; Adult; Female; Heroin; Humans; Injections, Intravenous; Male; Substance-Related Disorders

A total of 51 (34 men and 17 women) heterosexual alcoholic inpatients were assessed with respect to their engagement in high-risk behaviors for HIV infection and AIDS. Results indicated that a subset of the subjects engaged in frequent and diverse high-risk sexual activities, often had several different sexual partners over a 6-month period, frequently used drugs during sexual activities and sometimes used drugs intravenously. The frequency of high risk behaviors was similar for men and women, but minority subjects engaged in higher levels of high-risk behaviors than did whites. Both age and educational level were inversely related to behavioral risk for HIV infection. Although the current findings are limited due to sample size and representativeness, the results indicate that future research needs to focus on high-risk behaviors for HIV infection among alcoholics, with more attention directed toward prevention and intervention strategies.

Topics: Acquired Immunodeficiency Syndrome; Alcoholism; Cocaine; Heroin; Humans; Pilot Projects; Risk Factors; Sexual Behavior; Substance Abuse, Intravenous

Topics: Acquired Immunodeficiency Syndrome; Administration, Inhalation; Heroin; Heroin Dependence; Humans; Injections, Intravenous; Risk Factors

Data from 110 IV-drug abusing persons in methadone maintenance were analyzed to determine the correlates of needle sharing. Sharing was directly related to peer group behavior, attitudes conducive to sharing, economic motivation to share, not owning injection equipment, and fatalism about developing AIDS. Sharers were aware of their AIDS risk. Indicated measures to reduce needle sharing would be positive peer support groups to help resist pressures to share, legal and free access to fresh injection equipment, education on the utility of risk reduction, and increased treatment options for IV cocaine users.

Topics: Acquired Immunodeficiency Syndrome; Adult; Attitude to Health; Cocaine; Cross-Sectional Studies; Female; Heroin; Humans; Injections, Intravenous; Male; Needles; New York City; Peer Group; Sterilization; Substance-Related Disorders

Topics: Acquired Immunodeficiency Syndrome; Aflatoxins; Drug Contamination; Heroin; Heroin Dependence; Humans

Topics: Acquired Immunodeficiency Syndrome; Cocaine; Health Policy; Heroin; Humans; Injections, Intravenous; Narcotics; National Institutes of Health (U.S.); Substance-Related Disorders; United States; United States Public Health Service

Topics: Acquired Immunodeficiency Syndrome; Drug and Narcotic Control; Heroin; Heroin Dependence; Humans; Injections, Intravenous

Topics: Acquired Immunodeficiency Syndrome; Heroin; Humans; Illicit Drugs; Injections, Intravenous; Scotland; Social Problems; Substance-Related Disorders

Topics: Acquired Immunodeficiency Syndrome; Administration, Oral; Adolescent; Adult; Heroin; Humans; Injections, Intravenous; Male; Methadone; Patient Dropouts; Substance-Related Disorders

Sudden and unexpected death and violent death of persons with a high risk of acquiring HIV-infections, especially homosexual males and intravenous drug abusers, have to be investigated by forensic autopsies. Therefore every forensic pathologist has to be aware of this infection and should try to make the proper diagnosis. Three typical cases are described: (1) suicide by hanging, (2) homicide by cutting the throat and (3) intravenous heroin overdose. Merely retrospectively it could be cleared up that the deceased were homosexual but did not manifestly suffer from AIDS. The morphological findings in the lymph nodes and the postmortem serological findings are described in detail.

Topics: Acquired Immunodeficiency Syndrome; Adult; Antibodies, Viral; Autopsy; Enzyme-Linked Immunosorbent Assay; Fluorescent Antibody Technique; Forensic Medicine; Heroin; HIV; Homicide; Humans; Hyperplasia; Immunologic Techniques; Lymph Nodes; Male; Suicide

Issues regarding the use of epidemiology in drug abuse research are discussed and systems for monitoring national trends and identifying risk factors are described. Data indicate a general decline in marijuana use among youth, a cohort aging effect among heroin and marijuana users, and increased prevalence and health consequences associated with cocaine use.

Topics: Acquired Immunodeficiency Syndrome; Adolescent; Adult; Child; Cocaine; Epidemiologic Methods; Female; Heroin; Humans; Male; Marijuana Abuse; Population Surveillance; Risk; Substance-Related Disorders

In epidemiologic case-control studies and occupational cohort studies involving more than one exposure, it is sometimes of interest to investigate the possibility that two exposures or factors have an effect that is mutually enhancing. This paper begins with a simple classic model for independence of effect and describes how this model can be applied to cohort and case-control studies. A ratio index, borrowed from the toxicologic literature, can be used to quantify departures from this null model for prospective cohort studies. Models additive in log nonresponse are appropriate in this context. Proper stratification will remove confounding effects, although the possibility that covarying susceptibilities among individuals in the population are masking or producing the appearance of synergy remains. However, under a generalized null model that requires simple independent action for each individual, but allows the response probabilities to vary among individuals, the population-based ratio parameter may not be one but should lie in a specified interval. In a case-control setting, the simple independent action model implies that the ratio of the bivariate exposure distribution for cases, divided by that for controls, should be additive in functions of the exposure levels, generalizing an earlier result. The index takes a different form when one of the factors is preventive rather than causal, and in this context, models additive in log risk become appropriate. An example is provided, and difficulties in interpretation are discussed.

Topics: Abortion, Spontaneous; Acquired Immunodeficiency Syndrome; Biometry; Caffeine; Epidemiologic Methods; Female; Heroin; Humans; Illicit Drugs; Models, Biological; Pregnancy; Risk; Smoking

The Centers for Disease Control hierarchical classification of those at risk for acquired immunodeficiency syndrome (AIDS) underestimates the number of cases in which illicit drug use may play a role in the exposure to human T-cell leukemia virus type III. The immunosuppressive effects of nitrite inhalants are not sufficiently documented to elucidate their role as a cofactor in the development of AIDS. The currently available data on the immunosuppressive effects of self-administered parenteral drugs and their diluents indicate an associated elevation of immunoglobulin M, depressed helper/suppression T-cell ratios, and even damage to DNA. Illicit psychoactive drugs and their diluents may influence the virulence of the virus among parenteral drug users. An association between parenteral drug use and prostitution is not unexpected. Female prostitutes who use parenteral drugs may be at high risk for exposure to the virus and thus may transmit this infectious agent to their clients and their families.

Topics: Acquired Immunodeficiency Syndrome; Amyl Nitrite; Antibodies, Viral; Chromosome Aberrations; Cocaine; Female; Heroin; Heroin Dependence; HIV Antibodies; Humans; Immune Tolerance; Immunoglobulin M; Injections, Intravenous; Male; Retroviridae Infections; Risk; Substance-Related Disorders; T-Lymphocytes; United States

We studied the demographic characteristics, drug use patterns, and sexual habits of intravenous (IV) drug abusers to further define this population at risk for acquired immunodeficiency syndrome (AIDS). Sixteen IV drug abuser patients with AIDS, 24 IV drug abuser patients with AIDS-related complex (ARC), and 14 IV drug abuser controls without evidence of AIDS or ARC were evaluated. The subjects in each group were similar demographically, in drug use practice, and in sexual orientation and experience. Of the AIDS and ARC patients, 34 (88%) of 40, including all seven homosexual men, shared needles, as did all drug abusers without AIDS or ARC. Seventy-four percent of patients, including all homosexual men, attended "shooting galleries," where anonymous multiple-partner needle sharing took place. Needle sharing supports the hypothesis of AIDS transmission by a blood-borne route, can explain the spread of AIDS and the high rate of seropositivity to the putative AIDS agent among IV drug abusers, and is a logical link between IV drug abusers and male homosexuals, the two largest groups with AIDS.

Topics: Acquired Immunodeficiency Syndrome; Adult; Cocaine; Demography; Female; Heroin; Humans; Injections, Intravenous; Male; Middle Aged; New York; Nitrites; Puerto Rico; Sexual Behavior; Skin Tests; Substance-Related Disorders; T-Lymphocytes

A population including homosexual or heroinoman patients with lymphadenopathy is reported with special reference to Beta-2-microglobulin. This molecule seems to be more related to concomitant infection rather than to a high risk group. Thus, elevated Beta-2-microglobulin is useful to exclude infected donors but no high risk SIDA population.

Topics: Acquired Immunodeficiency Syndrome; beta 2-Microglobulin; Blood Donors; Heroin; Homosexuality; Humans; Lymphatic Diseases; Risk; Substance-Related Disorders

Fourteen previously healthy young patients with unusual community-acquired opportunistic infections were seen over a period of three years. They differ from patients previously described in that 11 were heterosexual drug abusers (including two women) and only three were homosexual men. There were eight Puerto Ricans, five blacks, and one white. Infections included Pneumocystis carinii pneumonia (seven), disseminated Mycobacterium intracellulare infection, histoplasmosis, cryptococcosis, and cytomegalovirus infection (one each), oral thrush (13), and Candida esophagitis (two). All patients had impaired cellular immunity manifested by cutaneous anergy and lymphopenia, and all 11 tested had a markedly decreased ratio of T helper/inducer cells to T suppressor/cytotoxic cells. Twelve had evidence of associated viral infection (Epstein-Barr virus in nine, cytomegalovirus in five, Herpes simplex type 2 in two). Clinical presentation was with a severe opportunistic infection or with a prodrome consisting of oral thrush and nonspecific findings including malaise, fever, lymphadenopathy, or cough. The syndrome of immunodeficiency and opportunistic infection occurs in nonwhite heterosexual drug abusers, not exclusively in white homosexual men, and patients may present for medical care before the onset of a severe opportunistic infection.

Topics: Acquired Immunodeficiency Syndrome; Adult; Black People; Candidiasis, Oral; Female; Heroin; Homosexuality; Humans; Immunity, Cellular; Infections; Male; New York City; Pneumonia, Pneumocystis; Puerto Rico; Substance-Related Disorders; T-Lymphocytes; T-Lymphocytes, Regulatory; Virus Diseases

A new syndrome of acquired immunodeficiency has been identified in seven children who were small for gestational age at birth and subsequently have exhibited failure to thrive, lymphadenopathy, parotitis, hepatosplenomegaly, interstitial pneumonia, and recurrent infections. All have a profound cell-mediated immunodeficiency with reversed T4/T8 ratios. Six are hypergammaglobulinemic and one has low IgG levels. The mothers of five of the seven children are sexually promiscuous and/or drug addicts. Three mothers have an immunodeficiency similar to that found in their infants. One of them died at age 33 years with a diagnosis of acquired immunodeficiency syndrome. In five of the children and in three of their mothers, there is evidence of a persistent Epstein-Barr virus (EBV) infection. We speculate that a perinatal or in utero transmission of EBV can induce an "infectious immunodeficiency." The clinical, histopathologic, and immunologic features resemble those described in adult homosexuals and drug addicts.

Topics: Acquired Immunodeficiency Syndrome; Age Factors; Child, Preschool; Female; Heroin; Humans; Infant; Male; Maternal-Fetal Exchange; Pregnancy; Prenatal Exposure Delayed Effects; Sexual Behavior; Substance Withdrawal Syndrome; Substance-Related Disorders; T-Lymphocytes; T-Lymphocytes, Helper-Inducer; T-Lymphocytes, Regulatory

Twenty-five ambulatory patients with acquired immunodeficiency syndrome (AIDS) were studied over a 6-month period. Fourteen (56%) of the patients were heterosexuals with a history of intravenous drug abuse. Ocular involvement was seen in 40% of patients, cotton-wool spots being the major manifestation. Findings consistent with cytomegalovirus retinitis were seen in only one patient. Ophthalmologists should be aware of the ocular findings and epidemiology of AIDS.

Topics: Acquired Immunodeficiency Syndrome; Adult; Cytomegalovirus Infections; Eye Diseases; Female; Fluorescein Angiography; Heroin; Humans; Male; Middle Aged; Retinal Diseases; Retinitis; Sarcoma, Kaposi; Skin Neoplasms; Substance-Related Disorders