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Biomedical subjects

J D Rich

Publications and source records attributed to J D Rich.

At least 37 records · Page 2Linked to original sources
PubMed2000

Strategies to optimize the impact of needle exchange programs.

In the United States today, half of all new HIV infections are injection drug use-associated, many of which are a result of the reuse and sharing of contaminated syringes. Thus, providing access to sterile syringes for injection drug users is an important part of preventing HIV transmission. Needle exchange programs (NEPs) have been established as one successful approach to providing sterile injection equipment. The medical literature shows that these programs are effective in decreasing both syringe sharing and HIV incidence in injection drug users. In addition, many NEPs are also beneficial because they provide other injection drug use-relevant services. There are several strategies that can be adopted in order to optimize the impact of needle exchange programs, at both the community and national levels. These include establishing NEPs in communities that need them, expanding and improving those that already exist, and implementing such programs on a larger national scale with the provision of federal funds.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Prevalence and incidence of HIV among incarcerated and reincarcerated women in Rhode Island.

This study explores recent temporal trends in HIV prevalence among women entering prison and the incidence and associated risk factors among women reincarcerated in Rhode Island. Results from mandatory HIV testing from 1992 to 1996 for all incarcerated women were examined. In addition, a case control study was conducted on all seroconverters from 1989 to 1997. In all, 5836 HIV tests were performed on incarceration in 3146 women, 105 of whom tested positive (prevalence, 3.3%). Between 1992 and 1996, the annual prevalence of HIV among all women known to be HIV-positive was stable (p = .12). Age >25 years, nonwhite race, and prior incarceration were associated with seropositivity. Of 1081 initially seronegative women who were retested on reincarceration, 12 seroconverted during 1885 person-years (PY) of follow-up (incidence, 0.6/100 PY). Self-reported injection drug use (IDU; odds ratio [OR], 3.7; 95% confidence interval [CI], 1.3-10.1) was significantly associated with seroconversion, but sexual risk was not (OR, 1.1; 95% CI, 0.4-3.5). Incarceration serves as an opportunity for initiation of treatment and linkage to community services for a population that is at high risk for HIV infection.

Case-Control Studies↗
PubMed1999

Needle exchange program participation by anabolic steroid injectors, United States 1998.

A significant number of people are currently misusing and abusing anabolic steroids. Hepatitis B, C, and HIV have all been documented to occur among anabolic steroid injectors (ASIs), most likely from the sharing of injection equipment. A survey was administered to 42 needle exchange programs (NEPs) from 17 states in the US to determine ASI participation. Sixty percent of the NEPs surveyed reported having at least some ASIs as participants, however, only 512 ASIs were identified among the 36,000 total monthly participants (1.4%). With the expanding number of NEPs in the US, it is possible to reach a higher proportion of ASIs with clean syringes and education, thus offering the means to prevent the spread of infection in this population.

Anabolic Agents↗
PubMed1999

Obstacles to needle exchange participation in Rhode Island.

OBJECTIVE: This study explores obstacles to participation in needle exchange programs (NEPs) among injection drug users (IDUs) in the state of Rhode Island, U.S.A. METHODS: A written questionnaire was administered at two Rhode Island drug detoxification sites in 1998. RESULTS: 488 self-administered surveys were completed, 226 (46.3%) respondents had injected drugs in the past 6 months. 62.1% reported sharing syringes in the past 6 months, and each syringe was used a mean of 10.7 times. Major obstacles to NEP participation were a lack of awareness of the program (25.6%), inconvenient location or hours (15.9%), and fear of identification and/or police harassment (12.2%). Non-white race was a significant predictor of being unaware of the NEP (p = .01) and not participating in the NEP (p = .03). 13.1% of IDUs who used the NEP were referred to the detoxification program by the NEP. Among all IDUs surveyed, 51.0% had participated in a NEP. CONCLUSIONS: NEPs are important in reducing the spread of bloodborne pathogens among IDUs and are effective referral sources for drug treatment. Surveys of IDUs at sites other than NEPs, such as detoxification facilities, can identify obstacles to the use of NEPs.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Misdiagnosis of HIV infection by HIV-1 plasma viral load testing: a case series.

BACKGROUND: The availability of sensitive assays for plasma HIV viral load and the trend toward earlier and more aggressive treatment of HIV infection has led to the inappropriate use of these assays as primary tools for the diagnosis of acute HIV infection. OBJECTIVE: To describe limitations in the use of plasma viral load testing for the diagnosis of HIV infection. DESIGN: Case series. SETTING: Academic medical centers in Providence, Rhode Island, and Worcester, Massachusetts. PATIENTS: Three persons in whom HIV infection was falsely diagnosed by plasma viral load testing. MEASUREMENTS: Laboratory measures and clinical outcomes. RESULTS: Two cases of false-positive results obtained by using branched-chain DNA plasma viral load assays and one case of a false-positive result obtained by using reverse transcriptase-polymerase chain reaction plasma viral load assay are reported. All three plasma viral load tests yielded positive results with low values (1254 copies/mL, 1574 copies/mL, and 1300 copies/mL). Infection with HIV was initially diagnosed in all three patients, but each patient subsequently tested negative by HIV-1 enzyme-linked immunosorbent assay and repeated plasma viral load testing. CONCLUSION: Physicians should exercise caution when using plasma viral load assays to detect primary HIV infection, particularly when the pretest probability of infection is low.

Adult↗
PubMed1999

Persistent parvovirus B19 related anemia of seven years' duration in an HIV-infected patient: complete remission associated with highly active antiretroviral therapy.

A human immunodeficiency virus (HIV)-infected individual was first diagnosed with red blood cell aplasia due to B19 parvovirus infection in late 1989. Over the subsequent seven-year period, he received a total of 119 units of red blood cells (RBCs) and intravenous immunoglobulin every 2-3 weeks. In 1996 combination antiretroviral treatment with a protease inhibitor was initiated. He received four more units during the following two months and then required no more transfusions for the subsequent 24 months of follow-up. His CD4 count progressively increased and DNA polymerase chain reaction for parvovirus B19 became undetectable. Aggressive antiretroviral treatment may effectively diminish transfusion requirements among HIV-infected individuals with pure RBC aplasia resulting from parvovirus B19 infection.

Adult↗
PubMed1999

Use of cerebrospinal fluid shunt for the management of elevated intracranial pressure in a patient with active AIDS-related cryptococcal meningitis.

Persistently elevated intracranial pressure (ICP) is one of the most accurate predictors of a poor prognosis in patients with AIDS-related cryptococcal meningitis. We present a severe case of persistent cryptococcal meningitis in a patient with advanced AIDS, complicated by elevation of ICP. A ventriculoperitoneal shunt was placed that successfully lowered the ICP and alleviated the associated symptoms. The elevated ICP secondary to AIDS-related cryptococcal meningitis should be treated aggressively. Despite the risk of shunt complications, cerebrospinal fluid shunts can be considered in these patients if they do not respond to other treatment.

AIDS-Related Opportunistic Infections↗
PubMed1999

Long-term non-progression of HIV-1 in a patient coinfected with HTLV-II.

A 37-year-old man coinfected with HIV-1 and human T-lymphotropic virus type II presumably through injection drug use had a high CD4+ count and low HIV viral load without anti-retroviral therapy for over six years. As an HIV long-term non-progressor, his case supports the hypothesis that coinfection with HTLV-II does not adversely affect the course of HIV disease.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Highly active antiretroviral therapy leading to resolution of porphyria cutanea tarda in a patient with AIDS and hepatitis C.

The association between HIV infection and porphyria cutanea tarda (PCT) is not well established. Since almost all HIV-infected patients with PCT previously described in the literature had additional risk factors for PCT, it is still unclear if HIV infection and not a cofactor such as hepatitis C virus is the trigger for PCT in this population. We describe a patient with AIDS and hepatitis C who developed bullous lesions due to PCT. The cutaneous lesions persisted for 18 months and resolved after he was placed on highly active antiretroviral therapy for HIV. No other therapeutic interventions were undertaken, while exposure to other known precipitants remained unchanged. During follow-up, skin lesions reappeared when the patient discontinued antiretroviral therapy, but PCT lesions again resolved after he restarted highly active antiretroviral therapy and HIV infection was controlled. This case supports the hypothesis that a direct causative relationship exists between HIV and the development of PCT.

Acquired Immunodeficiency Syndrome↗
PubMed1999

The infectious complications of anabolic-androgenic steroid injection.

One million individuals in the United States alone are estimated to be current or past users of anabolic-androgenic steroids. In the United States fifty-percent of anabolic-androgenic steroid users administer their compounds intramuscularly, and twenty-five percent of adolescent anabolic-androgenic steroid users share needles, placing these young adults at risk for infections related to injection. To examine the medical literature for reports of infections attributable to anabolic-androgenic steroids, we conducted a MEDLINE (1966-1998) and AIDSLINE (1980-1998) world literature review to examine all references that attributed infections to anabolic-androgenic steroid injection. Infections associated with anabolic-androgenic steroid injection include three cases of HIV, one case of hepatitis B, one case of hepatitis C, eight abscesses, and a case of fungal endophthalmitis. No cross-sectional or prospective studies exist that document the risk of infections related to anabolic-androgenic steroid injection. These serious infectious complications of anabolic-androgenic steroid injection may be avoided with education and prevention techniques. Infections occurring in anabolic-androgenic steroid users are not as common as in intravenous drug users.

Adult↗
PubMed1999

Reduction in recidivism of incarcerated women through primary care, peer counseling, and discharge planning.

Prior to release from the Rhode Island state prison, women at the highest risk for reincarceration and HIV infection are assigned to the Women's HIV/Prison Prevention Program (WHPPP), a discharge program designed to reduce the likelihood of reincarceration and HIV infection. Candidates for the WHPPP must meet at least one of three criteria: intravenous drug use or crack use, commercial sex work, or a history of prison recidivism with poor educational history and poor employment prospects. While incarcerated, the program participant develops a relationship with a physician and a social worker and establishes an individualized discharge plan. After release, the same physician and social worker continue to work with the client and assist an outreach worker in implementing the discharge plan. Data were collected from questionnaires administered to 78 women enrolled in the WHPPP between 1992 and 1995. The population in this program was primarily composed of ethnic minorities (55%), 25-35 years of age (55%), unmarried (90%), had children (72%), and displayed a variety of HIV risk behaviors. The WHPPP recidivism rates were compared with those of a mostly white (65%), similarly aged (51% were between 25 and 35 years of age) historical control group of all women incarcerated in Rhode Island in 1992. The intervention group demonstrated lower recidivism rates than the historical control group at 3 months (5% versus 18.5%, p = 0.0036) and at 12 months (33% versus 45%, p = 0.06). Assuming that recidivism is a marker for high-risk behavior, participation in the WHPPP was associated with a reduction in recidivism and in the risk of HIV disease in this very high risk group of women.

Adult↗
PubMed1999

Abscess related to anabolic-androgenic steroid injection.

One million individuals in the United States, predominantly males under 25 yr of age, are current or past users of anabolic-androgenic steroids. Fifty percent of these young adults administer their drugs intramuscularly, placing them at risk for infections related to injection. We present here a case report of an injection-related thigh abscess in a 26-yr-old anabolic steroid injector who did not use sterile injection technique and reported sharing multidosage vials with two other weightlifting colleagues. Reported infections associated with anabolic-androgenic steroid injection include abscesses attributable to Mycobacterium smegmatis, Staphylococcus, Streptococcus, and Pseudomonas organisms as well as HIV, hepatitis B, and hepatitis C. These infections are primarily related to nonsterile injection technique, shared injection equipment, and are avoidable with appropriate prevention techniques. Education is needed to prevent infectious complications such as abscesses and blood-borne pathogens among anabolic-androgenic steroid injectors.

Abscess↗
PubMed1999

Hepatitis B and C in the context of HIV disease: implications for incarcerated populations.

HIV-infected inmates are often co-infected with hepatitis B and/or hepatitis C virus. To describe the burden of HIV in the incarcerated population today, one must consider the impact of co-infection. HIV may dramatically modify the course of viral hepatitis infection, especially chronic hepatitis C. The converse is uncertain: chronic hepatitis does not seem to accelerate HIV disease progression. In this article, we offer guidelines for selecting appropriate candidates for treatment among co-infected inmates.

Comorbidity↗
PubMed1998

Detection of HIV-1 nucleic acid and HIV-1 antibodies in needles and syringes used for non-intravenous injection.

BACKGROUND: HIV antibodies and HIV DNA have been detected in needles and syringes that have been used for intravenous injections in HIV-infected persons. During intravenous injection, blood is typically aspirated into the lumen of the syringe. During intramuscular or subcutaneous injection, however, blood is not usually introduced into the syringe. OBJECTIVES: To investigate the presence of HIV antibodies, HIV proviral DNA, HIV RNA, and human DNA in needles and syringes that had been used for intramuscular or subcutaneous injection in persons known to have HIV infection. METHODS: Discarded disposable needles and syringes used by health-care personnel for medically indicated intramuscular or subcutaneous injections of HIV-infected patients were collected. Residual material was extracted from the syringes. The extracts were analyzed by enzyme immunoassay for the presence of HIV antibodies. PCR was conducted to detect HIV and human DNA, as well as HIV RNA. RESULTS: HIV antibodies were detected in 16 (6.2%) out of 260 syringes. Human DNA or HIV-specific DNA were not detected. A second set of 80 syringes was collected to examine the presence of HIV RNA. HIV RNA was detected in three (3.8%) out of 80 syringes. CONCLUSION: This analysis demonstrates that the risk of transmitting HIV from syringes that have been used for intramuscular or subcutaneous injection may be low, but is not zero.

DNA, Viral↗