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PubMed1986

Exposure of intravenous drug users to AIDS retrovirus, Sydney, 1985.

A survey of a cohort of 200 intravenous (IV) drug users drawn from five drug referral agencies was conducted in Sydney in 1985 and revealed only one heterosexual male with antibodies to AIDS retrovirus (ARV). Contact tracing of sexual and needle-sharing partners resulted in the referral of a further four out of six at-risk individuals seropositive for ARV. This study indicates that ARV has now reached the IV drug-using population and could be spread further among IV drug users by sexual contact and by needle-sharing. We conclude that exposure to ARV among IV drug users is in its earliest stages in Australia. There is an urgent need to introduce measures such as contact tracing and screening of IV drug users to prevent further spread of ARV in this risk group.

Adult↗
PubMed2002

[Causes of death in HIV-infected French drug users, 1995-2000].

Since the decline in mortality among HIV-infected persons after introduction of highly active antiretroviral therapy, concerns related to co-morbidities have increased as they may impair vital prognosis, particularly in intravenous (IV) drug users. We describe firstly the changes in the distribution of the causes of death between 1995 and 2000 among IV drug users in the "Aquitaine Cohort" based on hospital information system, and secondly the distribution of the causes of death among IV drug users in the French national survey "Mortalité 2000" specifically set up in 2000 for optimal exhaustiveness. The total number of deaths declined between 1995 and 2000 and 1/3 were IV drug users. Deceased IV drug users were younger than other deceased patients, had longer median time from diagnosis of HIV infection and higher median CD4 cell count. Poor socio-economic conditions were notified in 55%. Among IV drug users, the proportion of AIDS-related deaths was above 75% in 1995 and below 30% in 2000. In 2000, 25% of deaths were HCV-related, 12% of deaths were due to accident, overdose or suicide, and 8% were due to non-AIDS non-HCV related cancer. Among IV drug users, improvement in vital prognosis requires to improve management of HCV infection and to take into account socio-economic conditions and other addictive behaviours like alcohol consumption and smoking.

Adult↗
PubMed1985

The incidence rate of acquired immunodeficiency syndrome in selected populations.

Population figures were obtained, and incidence rates of acquired immunodeficiency syndrome (AIDS) for the 12 months from June 1, 1983, to May 31, 1984, were estimated for single (never-married) men aged 15 years or older, intravenous (IV) drug users, Haitians living in the United States, persons with hemophilia A and B, female sexual contacts of male IV drug users, and blood transfusion recipients. Single men in San Francisco and Manhattan, IV drug users in New York City and New Jersey, hemophilia A patients, and recent Haitian entrants had the highest rates of disease (82.0 to 268.9 per 100,000). Male IV drug users and male Haitians were two to four times as likely to experience development of AIDS as were females in each group. Persons with hemophilia A had six times the incidence rate of AIDS as did those with hemophilia B. Persons with severe hemophilia A had three times the rate of those with moderate and seven times the rate of those with mild clotting factor deficiency. Although blood transfusion recipients and female sexual contacts of male IV drug users had much lower average yearly rates than did persons in the four other groups (0.4 to 9.4 per 100,000), they still had a higher incidence rate of AIDS than did persons not belonging to any of these groups (0.1 per 100,000).

Acquired Immunodeficiency Syndrome↗
PubMed1987

Knowledge about AIDS and high-risk behavior among intravenous drug users in New York City.

Two hundred and sixty-one intravenous (IV) drug users, distributed between a methadone maintenance program and a large detention facility in New York City, were interviewed about knowledge of AIDS, needle use practices, and risk-reduction efforts. Ninety-seven per cent of subjects recognized needle-sharing as an AIDS risk factor; subjects showed less awareness about the effectiveness of certain risk-reduction techniques and tended to over-estimate the risk of casual contact. Of those still sharing needles at the time of first becoming aware of AIDS, 63% reported having subsequently either stopped needle-sharing or ceased IV drug use entirely. Logistic regression analysis indicated that continued needle-sharing behavior was associated with the detention facility site and lower scores on an AIDS knowledge questionnaire; reduced needle-sharing was more evident among methadone program patients and among subjects with greater knowledge about AIDS. The most common reasons for continued needle-sharing among those who continued to share needles despite knowledge of risk were: 'need to inject drugs, with no clean needle available' and 'only share with close friend or relative', offered by 46 and 45% of subjects, respectively. Results suggest that certain subgroups of IV drug users have adopted risk-reduction measures in response to AIDS. Expanded educational programs, increased drug treatment capacity, and additional strategies addressing drug users' access to sterile injection equipment and the social context of needle-sharing may be necessary to curb the further spread of AIDS among IV drug users.

Acquired Immunodeficiency Syndrome↗
PubMed1988

A larger spectrum of severe HIV-1--related disease in intravenous drug users in New York City.

Increasing mortality in intravenous (IV) drug users not reported to surveillance as acquired immunodeficiency syndrome (AIDS) has occurred in New York City coincident with the AIDS epidemic. From 1981 to 1986, narcotics-related deaths increased on average 32% per year from 492 in 1981 to 1996 in 1986. This increase included deaths from AIDS increasing from 0 to 905 and deaths from other causes, many of which were infectious diseases, increasing from 492 to 1091. Investigations of these deaths suggest a causal association with human immunodeficiency virus (HIV) infection. These deaths may represent a spectrum of HIV-related disease that has not been identified through AIDS surveillance and has resulted in a large underestimation of the impact of AIDS on IV drug users and blacks and Hispanics.

Acquired Immunodeficiency Syndrome↗
PubMed1993

HIV infection and i.v. drug use: medical examiner cases in Essex and Hudson Counties, New Jersey.

Patterns of HIV infection and IV drug use in 697 Essex and Hudson Counties, New Jersey, 1986-1987 Medical Examiner (ME) cases, aged 15-59 years, were examined. All cases had toxicology tests for drugs and had been autopsied. Postmortem stored sera were blind-tested and confirmed for the presence of HIV-1-antibody by the New Jersey Department of Health. All cases and IV drug users were dichotomized according to the presence/absence of HIV-1-antibody and were then analyzed for differences in demographic and postmortem characteristics. Subjects were predominantly Black men aged 30-44 years; the 119 HIV(+) cases were even more likely to be Black or Hispanic and in the 30-44 age group. Evidence of IV drug use and HIV(+) status were very highly correlated; 86 of 181 IV drug users were HIV(+). There was a low rate of suicide among HIV(+) cases and IV drug users. Only 3 of 63 suicide victims were HIV(+), and they were the only IV drug users whose manner of death was certified as suicide. Cases with toxicology findings of both heroin and cocaine were most likely to be HIV(+), followed in order by those with heroin or cocaine alone present. Cocaine alone was the illicit drug most often present in toxicology tests on all cases. Among IV drug users, heroin with cocaine was most often present.

Accidents↗
PubMed1993

Clinical use of the erythrocyte sedimentation rate in the evaluation of febrile intravenous drug users.

STUDY OBJECTIVE: To investigate the use of the erythrocyte sedimentation rate in the evaluation of febrile IV drug users. DESIGN: Prospective observational cohort study. SETTING: Municipal hospital emergency department. TYPE OF PARTICIPANTS: One hundred six IV drug users aged 18 years or older, with rectal temperatures of 37.8 C or more. INTERVENTIONS: Clinical and laboratory variables were obtained by trained research assistants, using a standardized data collection instrument. RESULTS: The erythrocyte sedimentation rate was the only variable consistently associated with illness severity in both the univariate and multivariable analyses (P < .0001). At an erythrocyte sedimentation rate of 100 mm/hr or more, the test had a specificity of 96% (95% confidence interval, 81% to 100%). In contrast, the erythrocyte sedimentation rate displayed a relatively poor sensitivity at low values (88% [95% confidence interval, 77% to 95%] at an erythrocyte sedimentation rate less than 20). CONCLUSION: An erythrocyte sedimentation rate of 100 or more should be regarded as a marker for serious illness in IV drug users with fever, but a "normal" erythrocyte sedimentation rate of less than 20 does not reliably exclude the presence of serious disease in this patient population.

Adult↗
PubMed1992

Comparison of AIDS in women in rural and urban Georgia.

Through 1990, 308 cases of AIDS had been reported in female residents of Georgia (aged 13 years and older); 77 (25%) were white and 228 (75%) black. The mean age of the white women (43.8 years) was greater than that of the black women (34.5 years). One hundred sixty-six women were from Atlanta (metro Atl), the major metropolitan center in Georgia, and 142 (46%) from other regions of the state (other areas). Blacks represented 74% and 76% of all cases in women in metro Atl and other areas respectively. Of the 308 cases, 178 (58%) were related to intravenous (IV) drug use (99 metro Atl, 79 other areas), including 104 (58%) women who were IV drug users and 74 who were sexual partners of IV drug users. These proportions were similar in the two regions. Among cases related to IV drug use, 85 (86%) women in metro Atl and 69 (87%) women elsewhere in the state were black. The cumulative rate of AIDS in women in metro Atl (14.4/100,000) was twice that of women in the rest of the state (6.7/100,000). The rate for AIDS cases related to IV drug use in black women (27.8/100,000 population) was 19 times that in white women (1.5/100,000). The median survival of all women was significantly greater in metro Atl than in other areas (400 and 296 days respectively), with a difference also in those reported only with Pneumocystis carinii pneumonia (466 and 373 days respectively).

Acquired Immunodeficiency Syndrome↗
PubMed2000

Therapeutic guidelines for Pseudomonas aeruginosa infections.

Pseudomonas aeruginosa nowadays is encountered among the leading pathogen in (i) ICU pneumonia; (ii) nosocomial bacteremia and AIDS primary bacteremia; (iii) iv drug users endocarditis; (iv) exacerbations of cystis fibrosis; (v) malignant external otitis and 'swimmers's ear', and (vi) contact lenses keratitis and traumatic endophthalmitis. The most vulnerable nosocomial hosts are the neutropenics and the mechanically ventilated patients in whom mortality rate exceeds 30%. Virulence of P. aeruginosa is attributed to the elaboration of various enzymes and toxins. There is also worldwide emergence of multiresistant phenotypes to antipseudomonal antibiotics. Therapeutic guidelines should therefore be based on (i) continuous resistance surveillance; (ii) in vitro synergistic interactions of antibacterial agents; (iii) pharmacodynamic properties of antibiotics interpreted by optimal dosing and appropriate frequency of administration; and (iv) current information on the necessity for combination therapy using an aminoglycoside.

Anti-Bacterial Agents↗
PubMedDate not supplied

Risk behaviors for HIV infection in clients of Pennsylvania family planning clinics.

Responses from a statewide survey of risk behaviors among clients of Planned Parenthood clinics in Pennsylvania indicate that a sizable proportion of these women are at intermediate or high risk for exposure to the human immunodeficiency virus (HIV). Overall, nearly five percent of the 15,499 women in the sample reported personal behavior, or a partner's behavior, that placed them at high risk, while an additional 20 percent were at intermediate risk. Among all women surveyed, 13 percent had had three or more partners in the past year, 12 percent had had a sexually transmitted disease, four percent had partners who were intravenous (IV) drug users, two percent were either current or past IV drug users, one percent had bisexual partners and less than one percent had partners who had hemophilia or who were infected with the AIDS virus.

Adolescent↗
PubMedDate not supplied

Sentinel surveillance of human immunodeficiency virus infection in sexually transmitted disease clinics in the United States.

From April 1988 through December 1989, sera obtained for syphilis testing from consecutive patients attending 98 sexually transmitted disease (STD) clinics in 37 metropolitan areas were tested for antibodies to human immunodeficiency virus (HIV) in an unlinked (blinded) survey. HIV seroprevalence in STD clinics ranged from 0 to 38.5% (median, 2.3%), with the highest rates found in the Mid-Atlantic states, Florida, and Puerto Rico. The highest median rates were found in men who have sex with men (36.1%) and heterosexual intravenous (IV) drug users (4.1%). For heterosexual persons who do not report IV drug use, median rates were highest in the 35- to 39-year-old age group for men (6.4%) and the 30- to 34-year-old age group for women (0.9%). Among persons who do not report risk behaviors for HIV infection, men had substantially higher median rates of HIV infection than women (P less than 0.001, Wilcoxon Signed Rank test), and rates were positively correlated with HIV infection rates in IV drug users in the same clinic (Pearson correlation coefficient [r] = 0.8; P less than 0.001). Among heterosexual STD clinic patients who do not report IV drug use, the median HIV infection rate for blacks (1.8%) was at least 2 times higher than the median infection rates for hispanics (0.9%) and whites (0.7%). The results of this study show that HIV infection in STD clinic patients varies by geographic area, sex, race and ethnic group, and risk behavior.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Social relations and empowerment of sexual partners of i.v. drug users.

This paper examines social relations and roles of women sexual partners of IV drug users. It is argued that the Island socio-cultural environment does not provide the socio-structural conditions for individuals to organize groups and get the power to solve community problems. It is further assumed that individuals have resources in some of the positions they occupy. Therefore, ascertaining which resources are prevalent in which positions will allow interventionists to start the empowerment process. The data shows that IV drug users' sexual partners have a steady income from food stamp programs. They support the family, are heads of households, and are responsible for child rearing. The paper discusses how these resources can be used to start women getting the power to solve their problems and consequently prevent HIV transmission.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Influence of human immunodeficiency virus 1 infection and degree of immunosuppression in the clinical characteristics and outcome of infective endocarditis in intravenous drug users.

BACKGROUND: Immunosuppression caused by human immunodeficiency virus 1 (HIV) infection appears to modify the clinical characteristics and to increase the severity of several bacterial infections. The impact of HIV infection and the degree of immunosuppression on the clinical characteristics and outcome of infective endocarditis (IE) in intravenous (IV) drug users has not been well characterized. METHODS: Prospective cohort study among 292 consecutive IV drug users with IE diagnosed in 2 academic institutional hospitals in Barcelona, Spain, from January 1, 1984, to October 31, 1995. Serostatus of HIV infection was documented in 283 patients. We measured demographics, clinical and biological data, cause, echocardiographic findings, HIV serostatus and classification, CD4 cell count, complications, and mortality. RESULTS: Among the 283 episodes of IE, 216 (76.3%) were in HIV-infected patients and 67 (23.7%) in non-HIV-infected patients. Rate of IE per 1000 admissions ranged from 0.17 to 0.82 per year, peaking in 1989. Characteristics of IE independently associated with HIV infection were right-side involvement (odds ratio [OR], 7.6; 95% confidence interval [CI], 3.5-16.7), a micro-organism different from viridans streptococci (OR, 2.5; 95% CI, 1.1-5.9), duration of drug abuse longer than 5 years (OR, 5.0; 95% CI, 2.4-10.3), and white blood cell count of no more than 10 X 10(9)/L (OR, 2.2; 95% CI, 1.1-4.2). There were no significant differences in mortality due to IE according to HIV serostatus. Among the 216 patients with HIV infection, the variables independently associated with worse outcome were CD4 cell count lower than 0.200 x 10(9)/L and left-sided or mixed IE. CONCLUSIONS: Although there is a difference in clinical presentation in IE in IV drug users, outcome was similar according to their HIV status. However, among HIV-infected patients, severe immunosuppression and mixed or left-side valvular involvement were strong risk factors for mortality.

AIDS-Related Opportunistic Infections↗
PubMed1985

AIDS-like immunologic alterations in clinically unaffected drug users.

Peripheral blood lymphocyte subpopulations (PBLS) and HLA-DR phenotype have been evaluated in 30 IV drug users who were not affected by acquired immune deficiency syndrome (AIDS). A strongly significant reduction in helper/suppressor ratio was found in these subjects as compared to the control population. When the group under study was subdivided according to the presence or absence of signs of lymphadenopathy syndrome (LAS), the apparently unaffected individuals still had significant modifications in PBLS when compared with controls. These modifications were more marked in subjects within the LAS+ subgroup, who also showed a greater DR5 frequency than those belonging to the LAS- subgroup. The authors concluded that AIDS-like laboratory alterations are present in clinically unaffected IV drug users; the possible role of DR5 in conditioning different individual susceptibility is considered.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Intergenerational differences in i.v. drug use behaviors: implications for HIV prevention.

The spread of the human immunodeficiency virus through the IV-drug-using population poses a serious public health threat. The tendency is to consider one IV drug user much the same as another. However, there are likely subtle differences in the behaviors of IV drug users depending on sexual, ethnic, and age differences. This study looks at the IV-drug-using behaviors of young adults 18 to 25 and adults over the age of 40. The drugs injected and rates of injection do differ for the two groups. This would suggest that HIV prevention should be tailored in response to the age differences of the targeted drug users.

Adolescent↗
PubMed2001

[Changes in high-dose buprenorphine maintenance therapy at the Fleury-Merogis (France) prison since 1996].

Since the law of January 1994, the ministry of Health is responsible for inmate health in France. This law created medical wards inside French prisons by conventions between hospitals and prisons. Since July 1995, Fleury-Merogis state-prison is linked to the Sud-Francilien Hospital. During the last few years, more and more IV drug users have been incarcerated and the number of infectious diseases has increased (AIDS, hepatitis C and B). Risk behavior is rather frequent and it has become a major concern of public authorities to fight this evolution. Prisons are part of structures having to take care of IV drug users. A few months after the authorization of buprenorphine in France (March 1996), the ministry of Health decided to give access to this treatment for incarcerated IV drug users. The aim of this study is to present the evolution of maintenance medication by high dose buprenorphine in a big state-prison and to explain the difficulties we have to face. The aim of this study was also to present how this treatment can contribute to reducing infectious risks. Surveying prescription is under the control of the Pharmacy since 1995. We have studied since 1996 the number of prescriptions, segregating initialized inside the prison and prescriptions continued. We have also studied and evaluated the number of psychotropic drugs for each prescription since 1996 in "two test buildings". Evolution of self mutilations and reducing infectious risks support measures have also been studied.

Adolescent↗
PubMed1992

Septic arthritis in patients with acquired immunodeficiency syndrome with human immunodeficiency virus infection.

We have evaluated the presence and characteristics of septic arthritis in intravenous (iv) drug users with human immunodeficiency virus (HIV) infection. Sixteen patients with both HIV infection and septic arthritis were studied and compared with 5 patients with septic arthritis but no HIV infection. Clinical profile, laboratory findings at the time of onset, localization, causative organisms, mean hospitalization time and presence of complications were the same in HIV positive and HIV negative patients. Staphylococcus aureus was the most commonly isolated organism in both groups. We conclude that septic arthritis in HIV infected iv drug users is not uncommon, it is produced by the same organisms and presents similar characteristics to the ones found in iv drug users without HIV infection. Therefore, the presence of HIV infection does not appear to modify the characteristics of septic arthritis.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Survey of AIDS knowledge and behavior changes among Massachusetts adults.

In October 1987, 1,323 Massachusetts residents were randomly interviewed by telephone to explore their exposure to AIDS educational efforts, levels of knowledge about AIDS, and whether that knowledge modified their behavior. Gay/bisexual males, iv drug users and heterosexual respondents were compared as were blacks, Hispanics, and whites. While 81% of respondents had read or heard mass media stories about AIDS, in the previous week, only 5% had ever been counseled about AIDS by a physician. Over 97% of black (N = 152) and white respondents (N = 1,057), as well as gay/bisexual males (N = 21) and iv drug users (N = 33) were aware that HIV can be transmitted by homosexual or heterosexual intercourse and by sharing needles when injecting drugs. However, 9% of the 55 Hispanics interviewed were unaware of male homosexual transmission, and 7% did not know about heterosexual transmission or the risks of needle sharing. Twenty percent of Hispanics, compared with 9% of other respondents, did not know HIV can be transmitted sexually by someone who appears healthy. Fifty-two percent of gay/bisexual males, 27% of iv drug users, and 21% of those who had multiple heterosexual partners in recent years reported adopting abstinence, monogamous relations, or condom use to avoid HIV exposure. Those who continued risky behavior were just as knowledgeable about HIV transmission, but they were less likely to report that they worry a great deal about getting AIDS, 14% vs 32%. The results indicate that new strategies and resources are needed to educate Hispanics. Physicians need to counsel more persons about HIV transmission and further efforts are needed to translate knowledge about HIV transmission into behavior change to avoid the virus.

Acquired Immunodeficiency Syndrome↗