Human immunodeficiency virus infection in diabetic intravenous drug users

OBJECTIVE.--To evaluate the association between diabetes and human immunodeficiency virus (HIV) seroprevalence in a population of intravenous (IV) drug users. DESIGN.--Cross-sectional survey in a cohort of IV drug users. SETTING.--Community-based study clinic. SUBJECTS.--The study included 2921 individuals with a history of IV drug use in the past 10 years; over 90% had injected drugs in the past year and 77% in the past month; only 15% were receiving drug treatment. OUTCOME MEASURES.--The HIV seroprevalence among IV drug users with and without a history of diabetes. RESULTS.--Those IV drug users with a history of diabetes had significantly lower HIV seroprevalence (9.8%) than nondiabetic IV drug users (24.3%; P = .03). Despite similar duration and intensity of drug use and sexual practices, diabetic IV drug users tended not to share injection paraphernalia and were less likely to attend shooting galleries than nondiabetic IV drug users. CONCLUSION.--Our data suggest that the apparent protective effect of diabetes against HIV infection in IV drug users is most likely due to their safer injection practices afforded by their ready access to sterile injection equipment.     

Preliminary research on the co-infection of human immunodeficiency virus and hepatitis virus in intravenous drug users

Objective To confirm the close relationship of high co-infection rate between HIV and hepatitis virus in intravenous drug users (IVDUs).Methods Anti-HIV, HBV and HCV were detected by ELISA in the serum from 35 scattered and 15massed IVDUs. PCR and RT-PCR were performed to confirm the infection of HIV, HBV, HCV, HGVand TTV among the 15 massed intravenous drug abusers.Results Among the 50 IVDUs, the positive rates of anti-HCVl HBsAg, anti-HBe and anti-HBc were 92% (46/50), 12% (6/50), 10% (5/50) and 66% (33/50), respectively. In the samples of HBsAg positive, their HBeAg was also positive. Although the positive rate of serum markers was different in the massed IVDUs compared to the scattered IVDUs, no significant difference was shown.In the cases of massed IVDUs, the positive rates of HIV DNA, HBV-DNA, HCV-RNA, HGV-RNA,and TTV-DNA were 100% (15/15), 26. 6% (4/15), 53. 3% (8/15), 33. 3% (5/15) and 26. 6%(4/15), respectively. Among the 15 massed intravenous drug users, one was infected with HIV,HBV, HCV, HGV and TTV; two were infected with HIV, HBV, HCV and HGV; three were infected only with HIV; and the remaining had other forms of co-infection.Conclusion The co-infection rate of HIV, HBV, HCV, HGV and TTV in intravenous drug users is very high.     

静脉注射毒品者的血源性感染

目的了解静脉吸毒者的血源性全身感染状况，以指导诊断和治疗。方法将2001年1月-2004年12月收治的18例静脉吸毒者的全身感染作回顾性分析。结果全部病例均有右心感染性心内膜炎和多发性肺脓肿，伴发肺栓塞4例、多发性脑脓肿2例、丙型肝炎3例、乙型肝炎1例。血培养结果：金黄色葡萄球菌阳性13例，其中1例同时白色念珠菌阳性；铜绿假单胞菌阳性2例；草绿色链球菌阳性3例。予青霉素、阿米卡星、头孢他啶、去甲万古霉素等治疗6周左右，除伴发脑脓肿的2例死亡、伴白色念珠菌感染1例自动出院外，余均治愈。结论静脉吸毒者血源性全身感染常见有右心感染性心内膜炎、多发性肺脓肿、肺栓塞、多发性脑脓肿、丙型肝炎、乙型肝炎等，其中脑脓肿尤具致命性。血培养阳性率高，经合理治疗后效果较好。     

Hepatitis C virus in intravenous drug users

Sera from 172 intravenous drug users were tested for the presence of antibodies to hepatitis C virus (anti-HCV). The results were analysed in relation to aspects of the history of drug use and evidence of liver disease. The presence of anti-HCV was strongly associated with duration of intravenous drug use. Two-thirds of patients were anti-HCV seropositive within two years of commencing regular intravenous drug use, and there was 100% seropositivity among people injecting drugs for more than eight years. Seropositivity for hepatitis C virus closely paralleled exposure to hepatitis B virus, which was also endemic in this population. In contrast, only one patient tested positive for antibodies to the human immunodeficiency virus. The presence of anti-HCV correlated poorly with biochemical markers of hepatitis. About half the patients with anti-HCV had normal serum levels of alanine aminotransferase, whereas an abnormal liver biochemistry was frequently observed in anti-HCV seronegative subjects. Previous studies of non-A, non-B hepatitis that have used abnormal liver biochemistry as a marker have underestimated the prevalence of chronic hepatitis among intravenous drug users; the use of a specific screening test reveals that infection with hepatitis C virus is very common in this population.     

Entry of human immunodeficiency virus infection into a population of injecting drug users, Victoria, 1990

OBJECTIVE: To investigate the pathway by which the human immunodeficiency virus (HIV) is entering populations of injecting drug users (IDUs) in Victoria. DESIGN: A retrospective case-control study comparing the prevalence of self reported risk behaviour in HIV-infected and uninfected Victorian IDUs. SETTING: Subjects were recruited by trained peer outreach workers from their personal networks, community agencies and Fairfield Hospital outpatients, and by a research worker from the major metropolitan prison. PARTICIPANTS: People who had been resident in Victoria for the past 12 months and had injected an illicit drug more than once in the previous three years were eligible to participate. Sixty-two such people (28 HIV-infected, 34 not infected) were included in the study. MAIN OUTCOME MEASURES: The two main hypothesised portals of entry were from the non-IDU homosexual population in Victoria, and from HIV-infected IDUs elsewhere. RESULTS: male homosexual contact was the most consistent risk factor identified by this study (odds ratio [OR], 6.2; 95% confidence interval [CI], 1.7-23.8). Having lived in or visited Sydney before 1986 was also associated with being infected with HIV (OR, 13.2; 95% CI, 1.5-603), and this was associated with homosexuality. Infected IDUs reported more sharing of injecting equipment than controls (OR, 9.0; 95% CI, 1.5-92.5), particularly with sexual partners; when this was the case, they were more likely to always use the injecting equipment after their partner (61% of cases, 0% of controls; OR, greater than or equal to 4.1; P = 0.0006). CONCLUSION: Men who have a history of both homosexual contact and injecting drug use represent the group of IDUs at highest risk of HIV infection in Victoria. Although heterosexual and homosexual IDUs may have limited contact only, a larger epidemic of HIV infection in heterosexual IDUs could spread from homosexual IDUs through the sharing of injecting equipment.     

Cocaine use and HIV infection in intravenous drug users in San Francisco

We assessed risk factors for human immunodeficiency virus (HIV) infection in 633 heterosexual intravenous drug users. The HIV seroprevalence was 26% in blacks, 10% in Hispanics, and 6% in whites. Intravenous cocaine use significantly increased the risk of HIV infection, with a seroprevalence of 35% in daily cocaine users (odds ratio, 6.4; 95% confidence interval, 3.0 to 13.3). Black subjects were more likely to use cocaine regularly. Drug use in shooting galleries and sharing of drug injection equipment were also associated with HIV infection and were more common in cocaine users. By multivariate analysis, black race, daily cocaine injection by blacks and Hispanics, all other cocaine injection, heavy use prior to entry into methadone treatment by blacks, and use of drugs in shooting galleries were independent predictors of HIV infection. Methadone therapy was associated with substantial reductions in heroin use and some reduction in cocaine use, but 24% of cocaine users receiving methadone began or increased cocaine injection after entry into treatment.     

Antibodies to the human immunodeficiency virus in needles and syringes used by intravenous drug abusers

The sharing of needles and syringes by intravenous drug abusers has been recognized as a critical factor in the transmission of the human immunodeficiency virus (HIV). In an attempt to reduce the sharing of needles and syringes among intravenous drug abusers, a pilot sterile needle-and-syringe exchange programme was established in an inner city neighbourhood in Sydney. The contents of exchanged syringes were screened for antibody to HIV by the enzyme-linked immunosorbent assay (ELISA); reactive and borderline samples were tested further by the Western Blot method. Of a sample of 300 needles-and-syringes that were exchanged, three (1%) needles-and-syringes were confirmed as containing antibody-seropositive blood by both ELISA and Western Blot methods and thus as being potentially infectious. As only 70% of known positive-control syringes were detected in this study, the proportion of potentially infectious needles-and-syringes that was found may have underestimated the proportion of infectious injection equipment that was returned. These findings highlight the importance of the removal of used needles and syringes from circulation in addition to the supply of sterile equipment. This method of monitoring exchanged needles-and-syringes is suggested as a means to evaluate measures that are designed to reduce the transmission of HIV among intravenous drug abusers. The rapid implementation of sterile needle-and-syringe exchange programmes is imperative to stem the spread of HIV infection.     

人类免疫缺陷病毒感染的免疫学

全世界已经有超过二千万人死于获得性免疫缺陷综合征（又称艾滋病）。人类免疫缺陷病毒（HIV）是引起艾滋病的病原体，是由Montagnier在1983年发现的。HIV是一种逆转录病毒，有两条单链RNA组成，在逆转录酶的作用下，转录成前病毒双链DNA。HIV主要通过使CD4T细胞衰竭来破坏免疫系统。当CD4 T细胞降至全血200个／mm^-3时，免疫系统功能就会发生紊乱，并且会伴随机会性感染如结核杆菌、隐孢子虫等。本文概述了由于HIV感染引起的复杂、多面性的免疫反应，并重点介绍了CD4 T细胞衰竭的机制。Th1和Th2辅助细胞的平衡改变也与疾病的进展有关。为了控制此疾病，研究者设计了多种疫苗，并且有些疫苗已经进入了临床试验阶段。     

Intravenous drug users who present to the Albion Street (AIDS) Centre for diagnosis and management of human immunodeficiency virus infection

Intravenous drug users who presented to the Albion Street (AIDS) Centre for human immunodeficiency virus (HIV) antibody screening during the period March 1, 1985 to January 31, 1989, were included in this study. Information on medical history and HIV risk-related behaviour was collected by means of a standardized, computer-coded medical record. Of the 1222 intravenous drug users in this study, 72.3% were men, 26.9% were women and 0.8% were transsexual, with 60.1% of the total claiming exclusive heterosexuality. Of the sample, 40.2% were current intravenous drug users, and 86.8% recorded having shared needles and syringes. Among this sample, the over-all prevalence of HIV seropositivity was 14.5%. Of subjects who were diagnosed as HIV seropositive, 43.8% were homosexual men, 13.1% were bisexual men and 5.3% were heterosexual men. Of all intravenous drug users, 49.9% had a history of at least one sexually-transmitted disease, with 21.8% reporting a history of more than one. Fifty-two per cent of the sample reported that they had been infected with hepatitis B previously. There was no over-all increase in the annual rate of HIV infection among this population of intravenous drug users. The sexual activity and prevalence of hepatitis and other sexually-transmitted diseases among this group are suggestive of widespread, continuing risk behaviour.     

Lymphoreticular involvement in human immunodeficiency virus infection

Background: Although lymphadenopathy, hepatomegaly and splenomegaly are commonly seen in human immunodeficiency virus (HIV) infection, little is known about the prognostic significance of these findings.     

Prevalence of HIV infection among intravenous drug users in the United States

We reviewed 92 published and unpublished studies of the prevalence of infection with the human immunodeficiency virus (HIV) among intravenous drug users (IVDUs) in the United States. Human immunodeficiency virus seroprevalence among IVDUs in drug treatment programs in the United States ranged from 0% to 65%. Seroprevalence was highest in the Northeast (10% to 65%) and Puerto Rico (45% to 59%); lower in the South Atlantic (7% to 29%) and in the metropolitan areas of Atlanta, Ga (10%), Detroit, Mich (7% to 13%), and San Francisco, Calif (7% to 13%); and 5% or less in other areas of the West, the Midwest, and the South. Among IVDUs seen in drug treatment programs, risk of infection was not associated with gender or age but was associated with black and Hispanic ethnicity, male homosexual orientation, and certain intravenous drug-use practices. Cross-sectional and cohort studies indicated increases in seroprevalence of between 0% and 14% per year among IVDUs in treatment. We estimated that between 61,000 and 398,000 IVDUs in the United States were infected with human immunodeficiency virus, or 5% to 33% of the IVDU population. High rates of infection among IVDUs in treatment in the Northeast indicate the potential for rapid spread in regions where rates are currently low. An urgent need exists to monitor human immunodeficiency virus infection levels and trends more widely and to develop effective programs to reduce the further spread of human immunodeficiency virus infection among IVDUs.     

重视人类免疫缺陷病毒感染的检测和治疗

人类免疫缺陷病毒(human immunodeficiency virus,HIV)是获得性免疫缺陷综合征(艾滋病)(acquired immunodeficiency syndrome,AIDS)的病原体。艾滋病的流行已对世界经济发展和社会进步产生了重要影响,被称为“世纪瘟疫”。国内外众多临床及科研工作者致力于艾滋病的研究,以期有效控制其在全球的流行。目前已明确HIV的传播途径主要为性接触、血液及母婴垂直传播,其主要靶细胞为CD4^ T淋巴细胞。     

Neurological complications of human immunodeficiency virus infection

The protean neurological manifestations of human immunodeficiency virus (HIV) infection are reviewed. Both the central nervous system and peripheral nervous system may be affected and many of the complications may occur in individuals with acquired immunodeficiency syndrome (AIDS)-related complex, or who are seropositive for HIV alone as well as those with the established AIDS syndrome. Specific therapy is available for certain of these neurological conditions, but the clinical course in others is untreatable and progressive. Although it seems likely that the pathogenesis of some of these syndromes such as the AIDS-dementia complex are due to the direct effect of HIV on the nervous system, in others the neurological injury probably occurs as a consequence of the immunosuppression which HIV induces, or immune-mediated mechanisms.