Biomedical subjects
Publications and source records attributed to H W Haverkos.
This paper reviews the nature and extent of drug abuse-related HIV disease services in the rural United States. Issues concerning the delivery of HIV disease and substance abuse health care services in rural settings are outlined and discussed.
The HIV and drug abuse epidemics are intertwined, and drug abusers make up a significant proportion of reported AIDS patients. For a variety of reasons, it is difficult to collect and interpret data about each epidemic. It is even more difficult to determine the relationships between the two. In this paper, various epidemiologic studies in both fields are reviewed. Some strengths and limitations of those studies are discussed, and possible methods for improvement are identified.
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Several communicable infectious diseases, including AIDS, hepatitis B infection, gonorrhea, syphilis, and tuberculosis, are increasing among drug abusers. Drug abuse treatment programs may be ideal sites to identify those infections and initiate and maintain appropriate medical management. This paper reviews the epidemiology of those infections among drug abusers in the USA, presents rudimentary aspects of medical management of selected infectious diseases, and discusses the need to integrate infectious diseases, drug abuse treatment, and public health approaches if we are to reverse, or at least stabilize, the trends of those diseases.
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Kaposi's sarcoma (KS), the most common cancer in patients with acquired immunodeficiency syndrome (AIDS), occurs predominantly in homosexual men. However, the percentage of homosexual AIDS patients with KS has declined during the past 6 years. This and other findings suggest that one or more cofactors associated with the homosexual lifestyle, rather than a special viral strain, probably influence the development of KS in patients infected with the human immunodeficiency virus (HIV). Possible reasons for the decline include changes in homosexual behaviors, leading to the practice of safer sexual techniques, and a decrease in use of nitrite inhalants. Identification of the KS-AIDS cofactor(s) could be invaluable to developing prevention and treatment strategies.
We review epidemiologic studies aimed at identifying the cause(s) or cofactors for AIDS-related Kaposi's sarcoma (KS). The epidemiology of AIDS-related KS in the United States differs from that of other forms of KS. One important feature of the epidemiology of AIDS-related KS is that its occurrence by race is strikingly disproportional. We believe this maldistribution can shed light on recent discussions concerning the cause of AIDS-related KS, and we propose further studies to elucidate the etiology of AIDS-related KS.
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There is sufficient clinical and epidemiological evidence to suggest that HIV infection alone does not cause Kaposi's sarcoma (KS) in AIDS. Several possible "cofactors" have been proposed. There are several reasons to consider nitrite inhalants as a plausible choice as the KS cofactor. Identifying the KS cofactor in AIDS could prove valuable for prevention of the most common cancer afflicting AIDS patients. Clarifying the mechanisms by which HIV infection and the KS cofactor produce disease may have implications for other cancers and diseases.
The identification of cofactors in AIDS is a challenging scientific task. If successful, identifying cofactors could prove valuable in understanding the pathogenesis of HIV infection and AIDS and in the development of strategies to prolong survival and/or prevent complications in HIV-infected individuals. There is sufficient evidence to suggest the existence of a cofactor in KS in AIDS. Nitrite inhalants remain a leading candidate to be the KS cofactor. Until more is known to document or refute this specific virus-drug interaction hypothesis in the pathogenesis of KS in AIDS, clinicians should encourage their patients to avoid use of nitrite inhalants. This article was prepared by a Federal Government employee as part of official duties; therefore, the material is in the public domain and may be reproduced or copied without permission.
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Intravenous drug abusers constitute 25 per cent of the cases of the acquired immunodeficiency syndrome (AIDS) in adults in the United States of America and 21 per cent of such cases in Europe. The potential for the rapid spread of the human immunodeficiency virus (HIV) among intravenous drug abusers exists because such drug abusers commonly share drug injection equipment. The heterosexual and perinatal spread of AIDS is also largely associated with intravenous drug abusers, and drug abusers have been identified as a major vector for the spread of the AIDS epidemic as it is associated with intravenous drug abuse. As long as intravenous drug abusers are addicted, they will continue to be at risk of contracting AIDS. Thus, the primary AIDS prevention strategy must be to help addicts to stop using drugs. It is suggested that drug abuse treatment resources should be expanded and outreach programmes developed to encourage more intravenous drug abusers to enter treatment. AIDS risk-reduction counseling must also be provided to intravenous drug abusers who continue injecting drugs, and to addicts and their sexual partners to prevent the sexual spread of HIV. Vigorous AIDS prevention initiatives must be undertaken now, using the most promising intervention strategies, while simultaneously evaluating and refining these strategies.
AIDS is a serious public health problem for IVDAs in the United States and Europe. Although AIDS and HIV infection are concentrated in New York and New Jersey in the United States, and in Italy and Spain in Europe, AIDS has been diagnosed and reported among IVDAs in all 50 States of the United States and 16 countries in Europe. It is quite apparent that, once HIV is introduced into a group of IVDAs, it can spread readily between IVDAs, to their sexual partners, and to their children in utero. Unfortunately, one can only expect HIV seroprevalence rates and AIDS cases to continue to increase among IVDAs worldwide for at least the next several years. Concerted efforts to develop, implement, and evaluate potential prevention strategies among IVDAs are urgently needed.