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Biomedical subjects

J B Page

Publications and source records attributed to J B Page.

At least 37 records · Page 2Linked to original sources
PubMed1997

Injection drug users' practices and attitudes toward intervention and potential for reducing the transmission of HIV.

Miami is one of the major centers of illegal drug activity and has a significant proportion of AIDS cases among injection drug users (IDUs). Since Needle Exchange Programs (NEP) are illegal and therefore do not exist in the state of Florida, other strategies must play a large role in reducing the transmission of HIV among IDUs. In order to effectively communicate with IDUs about needle safety, it is necessary to understand the practices and culture of IDUs, including where and how the needle/syringes are obtained and used. Data from recent studies conducted in Miami and other local sites indicate that IDUs inject frequently, averaging more than 1,000 per year, per person. While the vast majority of IDUs feel it is very important to clean needles and to use a needle only one time, these sentiments are not always practiced. Furthermore, data indicate that the context where shooting takes place must be considered in the planning of HIV risk reduction interventions. These findings suggest the importance of understanding patterns of drug use, attitudes toward intervention, and the cultural context where risky behaviors occur. Although Needle Exchange Programs are illegal in Florida, intervention programs must still stress the importance of using only new needles, but since new needles cannot always be obtained, IDUs should be taught and motivated not to use contaminated drug paraphernalia.

Acquired Immunodeficiency Syndrome↗
PubMed1997

HIV testing among Haitian women: lessons in the recognition of risk.

Haitian women in Miami, Florida, responded to recruitment for testing of HIV antibody serostatus in ways that demonstrated the value of ethnographic methods for studying reactions to this kind of test, especially pre- and posttest counseling sessions. A total of 155 women between 14 and 61 years old, recruited in Miami in 1992 and 1993, participated. Response to testing identified three primary obstacles to the women's understanding of content presented in pre- and posttest counseling sessions: (1) their confusion about the meaning of positive versus negative, (2) the investigators' difficulty in communicating the concept of antibody, and (3) vagueness of the concept of window period between exposure and presentation of antibody. Retesting of a subset of Haitian participants helped to define sexual risk among these women in terms of having partners who had other partners and perception of supernatural risk.

AIDS Serodiagnosis↗
PubMed1997

Skills for HIV risk reduction: evaluation of recall and performance in injecting drug users.

Evaluation of recall and performance skills required to clean needles/ syringes was conducted in Dade County with 393 injecting drugs users (IDUs) in 1988-1989. The study was guided by a question of the extent of correct cleaning of needles/syringes. A free recall procedure which combined cognitive and psychomotor testing provided a means of verifying knowledge and skills. The results show that injecting drug users were able to learn and retain knowledge and skills necessary to prevent risk of HIV infection by use of needles/syringes. Tests of knowledge and performance 6 months after training showed high retention of the material learned. The population at risk is capable of reducing the spread of HIV. The impact would be greater with perfect performance, but even with partial performance, some preventative impact could be assumed provided exposure time to bleach exceeds 30 seconds.

Adult↗
PubMed1996

Detection of HIV-1 DNA in needle/syringes, paraphernalia, and washes from shooting galleries in Miami: a preliminary laboratory report.

Shared use of injection equipment (needle/syringes), registering, booting, and backloading are practices among injection drug users (IDUs) that increase the risk for transmission of human immunodeficiency virus type 1 (HIV-1). The sharing of injection paraphernalia (including cookers and cottons) and washwater for rinsing used needle/syringes and dissolving drugs could be potential sources for secondary transmission of HIV-1. Laboratory rinses were made from needle/syringes, cottons, and cookers obtained from shooting galleries, and washwaters were obtained from shooting galleries in Miami. Three rinses were analyzed and antibodies to HIV-1 proteins were detected by using Western blot and HIV-1 DNA was detected by using nested polymerase chain reaction (PCR) specific for the gag and envelope genes of HIV-1. Antibodies to HIV-1 proteins were detected in 12 (52%) of 23 rinses from visibly contaminated needle/syringes, in three (18%) of 17 rinses from cottons, in three (14%) of 21 rinses from cookers, and in one (6%) of 17 washwaters. No antibodies were detected in laboratory rinses from visibly clean needles. Using nested PCR followed by Southern blot confirmation of the amplified targets, HIV-1 gag gene DNA was detected in 16 (84%) of 19 and envelope gene DNA in 17 (85%) of 20 laboratory rinses from visibly contaminated needle/syringes. We detected gag and envelope gene DNA, respectively, in three (27%) and four (36%) of 11 cottons, in six (46%) and seven (54%) of 13 cookers, and in five (38%) of 13 and in 10 (67%) of 15 washwaters from shooting galleries. No HIV-1 DNA was detected in laboratory rinses from visibly clean needles. These results indicate that HIV-1 might be present in contaminated cottons, cookers, and washwaters as well as in contaminated needle/syringes at shooting galleries. Reduction of risks of exposure to HIV-1 among IDUs may require modification of behaviors that are ancillary to the act of injection, such as the use of common cookers, cottons, and washwater.

Blotting, Southern↗
PubMed1996

Cognitive correlates of long-term cannabis use in Costa Rican men.

BACKGROUND: Cognitive correlates of long-term cannabis use have been elusive. We tested the hypothesis that long-term cannabis use is associated with deficits in short term memory, working memory, and attention in a literate, westernized culture (Costa Rica) in which the effects of cannabis use can be isolated. METHODS: Two cohorts of long-term cannabis users and nonusers were studied. Within each cohort, users and nonusers were comparable in age and socioeconomic status. Polydrug users and users who tested positive for the use of cannabis at the time of cognitive assessment after a 72-hour abstention period were excluded. The older cohort (whose age was approximately 45 years) had consumed cannabis for an average of 34 years, and comprised 17 users and 30 nonusers, who had been recruited in San José, Costa Rica, and had been observed since 1973. The younger cohort (whose age was approximately 28 years) had consumed cannabis for an average of 8 years, and comprised 37 users and 49 nonusers. Short-term memory, working memory, and attentional skills were measured in each subject. RESULTS: Older long-term users performed worse than older nonusers on 2 short-term memory tests involving learning lists of words. In addition, older long-term users performed worse than older nonusers on selective and divided attention tasks associated with working memory. No notable differences were apparent between younger users and nonusers. CONCLUSION: Long-term cannabis use was associated with disruption of short-term memory, working memory, and attentional skills in older long-term cannabis users.

Adult↗
PubMed1996

Medication therapy among intravenous drug users (IDUs) with HIV infection.

With the identification of HIV-1 as the etiological agent of AIDS, infected people have pursued to varying degrees pharmaceutical treatment to arrest disease progress. This paper evaluates the use of AZT and other antiretroviral agents, as well as access to, and utilization of, medical and social services among intravenous drug users (IDUs) in Miami, Florida. An ongoing prospective study of street-recruited IDUs in Miami-Dade County identified 20 HIV-infected IDUs who had HIV disease (CDC classification IV), and took antiretroviral and other medications after intervention. Participants included 13 active and 7 inactive IDUs. Longitudinal data and in-depth interviews made possible detailed studies of participants during periods when they were taking antiretroviral medications. Those IDUs who are HIV-positive have also received intensive medical and social services. Participants in the study reported nausea, malaise, insomnia, and dysphoria upon initiating AZT therapy. Eleven readily attributed these symptoms to use of antiretroviral medications, primarily AZT. Nevertheless, 9 reported an overall positive impression of the drug's effects; seven despite initial negative reactions to the medication. These results, plus measurement of medication in the blood, indicate that the IDUs studied not only took the antiviral(s), but often were willing to do so in spite of this medication making them feel bad.

AIDS-Related Opportunistic Infections↗
PubMed1996

Predictors of survival in human immunodeficiency virus type 1-seropositive intravenous drug users.

In an ongoing prospective study of street-recruited intravenous drug users (IDUs) in Miami, Fla., 116 human immunodeficiency virus type 1 (HIV-1)-infected IDUs were monitored for up to 7 years. This provided an opportunity to evaluate baseline immunological parameters as potential predictors of survival among HIV-1-infected IDUs. As expected, HIV-1-infected IDUs who had an advanced stage of the disease (Centers for Disease Control and Prevention classification III or IV); p24 antigenemia; human T-cell leukemia virus type 1/2 seropositivity; low CD4 counts (< or = 200); low hemoglobin (< or = 14), high serum immunoglobulin A (IgA) (> 500 mg/dl), or high serum IgG (> or = 3,500 mg/dl) levels; or low proliferative responses to pokeweed mitogen (< or = 1,500 cpm) and to phytohemagglutinin (< or = 80,000 cpm) at baseline had worse survival rates. Results from multivariate Cox's models of survival showed that the baseline serum IgG level, serum IgA level, and CD4 count independently predict survival in HIV-1-infected IDUs. Cross-validation procedures verified the above-mentioned findings. These findings support the routine consideration of serum immunoglobulin levels in addition to CD4 count, especially in early evaluation of disease stage, as these evaluations may modify application of prophylaxis and treatment for HIV-1-infected IDUs. We recommend consideration of use of serum IgG and IgA as immunological markers for long-range prediction of survival in HIV-1-infected IDUs. These determinations are less onerous and more appropriate for use in field studies and financially less favored settings.

Adult↗
PubMed1995

Risk factors for HIV-1 seroconversion among injection drug users: a case-control study.

OBJECTIVES: A nested case-control study was conducted in Miami, Fla, to determine risk factors associated with human immunodeficiency virus type 1 (HIV-1) seroconversion among injection drug users. METHODS: The study identified 21 incident cases of HIV-1 infection and 76 unmatched controls from two longitudinal cohorts of injection drug users. One cohort consisted of individuals who originally had been recruited from treatment centers; a second cohort was recruited from the "street." Logistic regression analyses that adjusted for age, gender, and race were performed. RESULTS: The final model determined that the primary independent risk factor that best explained the risk for seroconversion was sharing injection equipment in the year prior to conversion; a marginal risk factor was presence of sexually transmitted disease during this same period. CONCLUSIONS: Both an injection component and a sexual component play a role in seroconversion among injection drug users, although the injection component is much stronger.

Adult↗
PubMed1994

Preliminary laboratory studies of inactivation of HIV-1 in needles and syringes containing infected blood using undiluted household bleach.

To evaluate the effectiveness of bleach disinfection of injection equipment, we tested HIV-1 inactivation by household bleach in needles and syringes. We obtained blood from HIV-1 infected injecting drug users (IDUs), placed small aliquots in needles and syringes. Blood with and without anticoagulant was incubated at room temperature for 3, 6, 18, and 24 h, and some needles and syringes from each condition were exposed to undiluted bleach for 15 and 30 s. The needles and syringes were then rinsed and the rinses were used to inoculate peripheral blood mononuclear cells (PBMNCs). HIV-1 replication was monitored using p24 enzyme linked immunosorbent assay (ELISA). We describe results that HIV-1 is inactivated in clotted and unclotted blood allowed to stand at room temperature for 3, 6, 18, and 24 h in needles and syringes using undiluted household bleach at 30 s of exposure time. These results are consistent with earlier findings that micropellets of HIV-1 were inactivated by bleach under similar conditions of exposure to bleach; 10% bleach was not effective at an exposure time of 30 s and undiluted bleach was not effective at an exposure time of 15 s to inactivate HIV-1 in clotted blood. Bleach concentration and exposure time are critical and HIV disinfection may not occur with inadequate exposure to bleach HIV.

Disinfection↗
PubMed1994

Compliance to bleach disinfection protocols among injecting drug users in Miami.

Bleach cleansing of injection equipment has been recommended to reduce the risk of human immunodeficiency virus (HIV) transmission associated with the reuse of injection equipment by injecting drug users (IDUs). We evaluated the recall and performance of the most commonly recommended bleach cleansing procedure of two complete fillings of the syringe with bleach, followed by two complete fillings with rinse water, and not putting used bleach and water back into source containers. IDUs were taught this procedure on enrollment in an HIV prevention demonstration project in Dade County, Florida. During follow-up session 6-12 months after initial training, the knowledge and ability of IDUs to perform bleach cleansing were assessed by trained observers using a standardized method. In 1988-90, we assessed the knowledge and ability of 450 IDUs to perform the bleach cleansing procedure taught at enrollment. More than 90% of IDUs assessed performed the basic steps. However, only 43.1% completely filled the syringe with bleach and only 35.8% completely filled the syringe with bleach at least twice. Substantial proportions of IDUs did not perform all the steps of the previously taught bleach cleansing procedure. Compliance decreased as the number of steps required was increased. This limited compliance may make bleach cleansing less effective and suggests that some IDUs may fail to adequately disinfect injection equipment and therefore sterile needles and syringes are safer than bleach-cleansed ones. Compliance testing can help assess the effectiveness of HIV prevention programs.

Disinfection↗
PubMed1993

Effects of retroviral infections on immune function in African-American intravenous drug users.

OBJECTIVES: To determine the effect of retrovirus infection and co-infection, and intravenous substance use, on immune function in African-Americans. DESIGN: A cohort of South Florida street-recruited African-American intravenous drug users formed the study population. The cohort consisted of 90 HIV-negative & human T-lymphotropic virus (HTLV)-negative, one HIV-negative & HTLV-I-positive, 11 HIV-negative & HTLV-II-positive, 79 HIV-positive & HTLV-negative, one HIV-positive & HTLV-I-positive and 21 HIV-positive & HTLV-II-positive individuals. The results reported are for the cross-sectional, baseline assessment of immune parameters. METHODS: Lymphocyte phenotypic distributions and functional markers, including proliferative response to mitogens and natural killer cell cytotoxicity, were determined. Serum immunoglobulin (Ig) levels were determined as a measure of B-cell activity. RESULTS: HTLV-II infection was associated with increases in CD8 lymphocyte count and serum Ig, but with no other significant immunologic changes. The distribution of CD4 and CD8 percentages, CD4:CD8 ratio, phytohemagglutinin (PHA) and pokeweed mitogen (PWM) reactivity, IgA and IgG for the four retrovirus serostatus groups suggested the possibility of interactive effects in the co-infected group, as demonstrated by a trend toward lower medians for CD4 and for PHA and PWM response and higher medians for IgG, IgA and CD8. Retrovirus-seronegative intravenous drug users had significantly impaired immune status compared with non-drug-using control individuals. CONCLUSIONS: Immunologic dysfunction attributable to HTLV-II infection was minor compared with HIV infection in this population. Study subjects who were co-infected with HIV and HTLV demonstrated more impairment of immune function than individuals with single retrovirus infections.

Adult↗
PubMed1991

The donation and sale of blood by intravenous drug users.

In spite of efforts to dissuade intravenous drug users (IVDUs) from donating or selling blood, some continue to do so. As part of a longitudinal study, 915 IVDUs in South Florida were interviewed concerning their history of donation or sale of blood and tested for antibodies to HIV-1 and HTLV-I/II. Approximately 17 percent had either donated or sold blood during 1985 through 1988; most contributors (80.4 percent) sold to commercial blood services. IVDUs who had donated/sold blood were more likely to be male and not in drug treatment than were those who had not contributed blood. IVDUs not in treatment at the time of interview were more likely than IVDUs in treatment to have sold blood. Of those who had donated/sold blood since 1985, 19.6 percent subsequently tested positive for antibodies to HIV-1 and 5.7 percent were positive for antibodies to HTLV-I/II. Increased effort is required to screen prospective donors and sellers, particularly at commercial blood banks.

Adult↗
PubMed1990

HTLV-I/II seropositivity and death from AIDS among HIV-1 seropositive intravenous drug users.

In a prospective study of street-recruited intravenous drug users (IVDUs) in Miami, Florida, USA, 107 (46.5%) of 230 IVDUs were infected with HIV-1. Of these HIV-1 seropositive individuals, 23 were also infected with human T-lymphotropic virus type I or II (HTLV-I/II). To test the hypothesis that HTLV-I/II infection has an effect on the survival of HIV-1 seropositive IVDUs, various baseline clinical and laboratory HIV-1 related indices in HTLV-I/II positive and negative groups were compared. Life table analysis and Cox's proportional hazards model were used to estimate the potential effect of HTLV-I/II infection on the survival patterns of people infected with HIV-1. IVDUs infected with both viruses were three times more likely to die from AIDS during follow-up than were those infected with HIV-1 only. This finding suggests that HTLV-I/II seropositivity may adversely affect the clinical outcome of HIV-1 seropositive patients.

Acquired Immunodeficiency Syndrome↗