heroin and Liver-Cirrhosis

People who use opioids and people living with HIV (PLWH) are at increased risk for liver-related morbidity and mortality. Although animal models suggest that chronic opioid use may cause liver damage, research in humans is limited. We aimed to determine whether opioid use, particularly heroin, was associated with liver fibrosis.. Cross-sectional analysis of 679 participants (295 HIV/HCV uninfected, 218 HIV mono-infected, 87 HCV mono-infected, 79 HIV/HCV coinfected) from the Miami Adult Studies on HIV (MASH) cohort. Liver fibrosis was assessed via magnetic resonance elastography (MRE) on a 3 T Siemens MAGNETOM Prisma scanner.. A total of 120 (17.7 %) participants used opioids. Liver fibrosis was present in 99 (14.6 %) participants and advanced liver fibrosis in 31 (4.6 %). Heroin use (N = 46, 6.8 %) was associated with HCV-seropositivity, smoking, misuse of prescription opioids, and polysubstance use. The use of heroin, but not misuse of prescription opioids, was significantly associated with liver fibrosis (OR = 2.77, 95 % CI: 1.18-6.50) compared to heroin non-users, after adjustment for confounders including excessive alcohol consumption, polysubstance use and HIV and HCV infections. Both HIV and HCV infections were associated with liver fibrosis, whether virally suppressed/undetectable or viremic.. Heroin use was independently associated with increased risk for liver fibrosis irrespective of the use of other substances and HIV or HCV infections. Both HIV and HCV were associated with higher risk for liver fibrosis, even among those with suppressed or undetectable viral loads. The exact mechanisms for opioid-induced liver fibrosis remain to be fully elucidated.

Topics: Adult; Analgesics, Opioid; Cohort Studies; Cross-Sectional Studies; Female; Florida; Hepatitis C; Heroin; HIV Infections; Humans; Liver Cirrhosis; Male; Middle Aged; Opioid-Related Disorders; Viral Load

Hunger strike of prisoners and detainees remains a major human rights and ethical issue for medical professionals. We are reporting on a case of a 48-year-old male sentenced prisoner, intravenous heroin user, who went on a hunger strike and died 15 days later. Throughout the fasting period, the prisoner, who was capable of decision making, refused any medical examination. Autopsy findings were not supporting prolonged starvation, while toxicology revealed benzodiazepines and opiates in blood and urine. Cause of death was given as "heroin intoxication" in keeping with detection of 6-MAM. Legal and ethical issues pertinent to medical examination and treatment of prisoners on hunger strike are explored in accordance with legislation and professional ethical standards in Serbia. A recommendation for the best autopsy practice in deaths following hunger strike has been made.

Topics: Carbamazepine; Codeine; Dissent and Disputes; Fasting; Forensic Toxicology; Heroin; Heroin Dependence; Humans; Liver Cirrhosis; Male; Middle Aged; Morphine; Morphine Derivatives; Narcotics; Prisoners; Serbia

The aim of the present work was to analyse, at the ultrastructural level, the action of heroin of 150 centrilobular sinusoids from liver biopsies of five intravenous drug abusers, who presented clinical and biological manifestations of hepatic impairment. A comparative study of 90 sinusoids from liver biopsies of three control patients was performed. Electron microscopic observations showed a thickening of the sinusoidal wall related to endothelial cell hypertrophy and to fibrosis of the space of Disse. This was generally associated with basement-membrane-like material and hepatocyte microvilli flattening. In addicts, hepatic vascular pole changes were a constant finding, accompanied by interhepatocyte space disjunction and perisinusoidal collagenization. Morphometric assessment confirmed a significant increase of sinusoidal wall surface, endothelial cell body and processes and Ito cell process surface was significantly different between the patient groups. This cellular hypertrophy may represent hyperactivation of the sinusoidal cell functional capacity, triggering the fibrogenesis in the space of Disse. While this mechanical barrier might hinder the free exchange through the space of Disse, it may equally well protect the liver against heroin toxicity.

Topics: Adult; Endothelium, Vascular; Extracellular Matrix; Heroin; Humans; Hypertrophy; Liver; Liver Cirrhosis; Male; Microscopy, Electron; Substance-Related Disorders

Hepatic cirrhosis is infrequently diagnosed in young adults. In a hospital for addictive diseases in New York City, we found cirrhosis in 53 patients under age 35 within just 40 months. The cirrhosis was biopsy-proven in 37 patients (group I) and diagnosed clinically in 16 patients with severe liver disease (group II). Alcohol abuse was found in 51 patients (96%), and parenteral heroin abuse was seen in 52 (98%). The duration of alcohol abuse was seven or fewer years in 24 patients (45%) and 10 or fewer in 39 (74%). In 44 (83%), the substance abuse began in adolescence. Comparison of group I cirrhotic patients with 65 non-cirrhotic biopsied patients showed that cirrhosis was significantly associated with abuse of both alcohol and parenteral heroin (p less than 0.001). The distribution of 66 HLA antigens from A, B, C, and DR loci showed no differences when 42 patients were compared with 42 ethnically-matched control substance abusers. The early development of cirrhosis in these young patients may be related to multiple hepatic injuries induced by alcohol and parenteral heroin abuse and to the onset of addictive diseases during adolescence or early adult life.

Topics: Adult; Age Factors; Female; Heroin; Histocompatibility Antigens Class II; HLA Antigens; HLA-DR Antigens; Humans; Injections; Liver Cirrhosis; Liver Cirrhosis, Alcoholic; Male; Substance-Related Disorders

Topics: Adult; Amphetamine; Anemia, Hemolytic; Barbiturates; Biopsy; Chronic Disease; Foreign Bodies; Foreign-Body Reaction; Heroin; Humans; Hypertension, Pulmonary; Injections, Intravenous; Liver; Liver Cirrhosis; Lung; Male; Methods; Microcirculation; Substance-Related Disorders; Tablets

Topics: Adult; Alcoholism; Child; Female; Hepatitis A; Heroin; Humans; Liver Cirrhosis; Liver Diseases; Lung Diseases; Male; Middle Aged; Oxygen Inhalation Therapy; Pneumonia; Respiratory Insufficiency; Syndrome

Topics: Adolescent; Adult; Aged; Burns; Colon; Endotoxins; Female; Gastrointestinal Hemorrhage; Heroin; Humans; Intestinal Obstruction; Ischemia; Kidney Transplantation; Liver Cirrhosis; Liver Diseases; Lung Diseases, Parasitic; Male; Middle Aged; Mononuclear Phagocyte System; Morphine Dependence; Peritonitis; Sepsis; Shock, Septic; Transplantation, Homologous; Urinary Fistula; Urinary Tract Infections

The rate of removal of a standard dose of 25 mg indocyanine green was studied in 67 patients at the bedside using dichromatic ear densitometry. The determination of the percentage disappearance rate per minute and the half life of the dye permitted separation of patients into three groups: those with normal liver function, those with liver damage, and a group taking opiates (9), anticonvulsants (8), phenylbutazone (2), haloperidol (1), and nitrofurantoin (1). The last group showed enhanced clearance of indocyanine green from the circulation.

Topics: Adult; Aged; Anticonvulsants; Densitometry; Drug Therapy; Ear, External; Female; Half-Life; Haloperidol; Hepatitis; Heroin; Humans; Indocyanine Green; Liver; Liver Cirrhosis; Male; Meperidine; Middle Aged; Morphine; Nitrofurantoin; Phenylbutazone; Stimulation, Chemical; Substance-Related Disorders