HIV risk behaviors among older American drug users

Despite increasing numbers of Americans older than 50 years of age, little is known about the impact of HIV/AIDS on aging drug users. The current study assesses the drug-related and sex-related HIV risk behaviors of older and younger injection drug users and crack smokers. Structured interview responses from 1508 out-of-treatment active drug users older than 50 years of age were compared with those of 1515 out-of-treatment active drug users who were 50 years old or younger. Comparisons were also made within the older cohort to examine differences in risk behaviors between crack smokers and nonsmokers, men and women, and users older than 60 years of age and those in their 50s. Results indicated that although older drug users (older than 50 years of age) were less likely to have had sex in the prior month, those who did were as risky as their younger counterparts with regard to sex-related risk behaviors. They were, however, significantly less risky in their needle sharing practices than those 50 years old or younger. Among the older cohort, those who smoked crack were extremely risky. Men older than 50 years of age were riskier than women older than 50 years of age; however, users older than 60 years of age were no less risky than those in their 50s. Interventions designed for older drug users should focus on sex risk behaviors, especially among those who smoke crack.     

经皮给药系统的研究进展

经皮给药系统作为一种非侵入式药物递送系统,与传统的注射、口服等给药方式相比具有许多优势,非常适用于需要频繁治疗或长期治疗的疾病.根据近年来经皮给药系统的研究进展,对经皮给药机制、影响药物经皮渗透的因素、促进药物经皮吸收的方法进行归纳和评述,并对经皮给药系统的未来发展趋势进行展望.     

可注射原位给药体系在蛋白类药物给药中的应用

可注射进入病灶部位并能原位给药的体系具有操作简单、局部给药、延长药物释放时间、减少用药剂量等诸多优点.近年来,各国研究者竞相研究可注射原位给药体系,并将其作为亲水性大分子药物尤其是蛋白类药物的药物载体.本文主要介绍了热塑性糊状体、原位交联聚合物体系、原位聚合物沉淀和热诱导凝胶体系四种缓释药物体系,着重讨论了将其作为蛋白类药物载体的优缺点.     

载药纳米微粒的临床应用研究进展

载药纳米微粒是纳米技术与现代医药学结合的产物 ,是一种新型的药物输送载体。它缓释药物、延长药物作用时间 ,透过生物屏障靶向输送药物 ,建立新的给药途径等等 ,在药物控释方面显示出其他输送体系无法比拟的优势。近年来载药纳米微粒在临床各个领域的应用基础研究势头强劲 ,并取得了可喜的成绩。本文综述了载药纳米微粒在临床各领域应用的研究成果 ,并对其发展应用前景进行展望     

Incidence and risk factors for hepatitis C among injection drug users in Baltimore, Maryland.

Between 1988 and 1996, the incidence of and risk factors for hepatitis C virus (HCV) infection were studied in a cohort of injection drug users in Baltimore, Maryland. By second-generation antibody testing of stored serum samples, 142 participants were found to be susceptible to HCV at the time they entered the study. After a median follow-up of 6.5 years, 43 participants (30.3%) developed antibodies to HCV (anti-HCV). The overall incidence was 6.4 cases per 100 person-years, but a substantial decline in the annual incidence rate was observed after the first 2 years (1988 to 1990, 13.4/100 person-years; 1991 to 1996, 2.3/100 person-years [P = 0.0001 for trend]). Participants who acknowledged active drug use, especially those who acknowledged frequent use and sharing of drug paraphernalia, were at increased risk of HCV infection. However, high-risk sexual practices were not associated with HCV seroconversion. Efforts to reduce HCV infection must be focused on curbing drug use and especially on the sharing of needles and drug paraphernalia.     

Personality patterns of drug abusers as shown by MMPI profiles

MMPI and 16 PF patterns of a group of drug abusers who were participating in a voluntary VA Drug Abuse Program were investigated. The MMPI profiles of 91 male veterans who ranged in age from 18-45 years were classified according to two-point code types. A comparison was made of the most frequently occurring code types among drug abusers, medical patients, and psychiatric patients. The two modal profile types among drug abusers were the 4-9/9-4 and the 2-4/4-2, which accounted for 32% of the sample. An additional comparison between the two modal types and responses to the 16 PF was made. Results indicate a closer resemblance to psychiatric patients than to medical patients, and the variety of high point code types is discussed. The similarity between the present sample of modal code types with research on drug abusers undertaken 20 years previously also is discussed.     

综合康复措施对慢性精神分裂症患者认知功能障碍远期疗效对照研究

目的比较包括药物治疗在内的综合康复措施和单纯药物治疗对慢性精神分裂症患者认知功能障碍的远期疗效。方法对在3年多前接受综合康复措施治疗的16例长期住院的慢性精神分裂症患者(研究组)在中断综合康复训练2年后,和单纯接受药物治疗的14例慢性精神分裂症患者(对照组),用简易智力状态检查量表(MMSE)、阴性症状量表(SANS)对认知功能和阴性症状进行再次评定。结果①MM SE:两组在定向力(t=4.820,P<0.01)、语言(t=5.466,P<0.01)方面的分值和总分值(t=6.1276,P<0.01)均有显著差异;②SANS:两组在思维贫乏(t=3.836,P<0.05)、注意障碍(t=2.248,P<0.05)方面的分值和总分值(t=2.435,P<0.05)均有差异。结论综合康复措施对改善慢性精神分裂症患者认知功能障碍有一定的远期疗效。     

Long-lasting reactivity and high frequency of drug-specific T cells after severe systemic drug hypersensitivity reactions

BACKGROUND: Drug-reactive T cells are involved in most drug-induced hypersensitivity reactions. The frequency of such cells in peripheral blood of patients with drug allergy after remission is unclear. OBJECTIVE: We determined the frequency of drug-reactive T cells in the peripheral blood of patients 4 months to 12 years after severe delayed-type drug hypersensitivity reactions, and whether the frequency of these cell differs from the frequency of tetanus toxoid-reactive T cells. METHODS: We analyzed 5 patients with delayed-type drug hypersensitivity reactions, applying 2 methods: quantification of cytokine-secreting T cells by enzyme-linked immunospot (ELISpot), and fluorescent dye 5,6-carboxylfluorescein diacetate succinimidyl ester (CFSE) intensity distribution analysis of drug-reactive T cells. RESULTS: Frequencies found were between 0.02% and 0.4% of CD4(+) T cells reacting to the respective drugs measured by CFSE analysis, and between 0.01% and 0.08% of T cells as determined by ELISpot. Reactivity was seen neither to drugs to which the patients were not sensitized nor in healthy individuals after stimulation with any of the drugs used. CONCLUSION: About 1:250 to 1:10,000 of T cells of patients with drug allergy are reactive to the relevant drugs. This frequency of drug-reactive T cells is higher than the frequency of T cells able to recognize recall antigens like tetanus toxoid in the same subjects. A substantial frequency could be observed as long as 12 years later in 1 patient even after strict drug avoidance. Patients with severe delayed drug hypersensitivity reactions are therefore potentially prone to react again to the incriminated drug even years after strict drug avoidance.     

Two-photon absorption-controlled multidose drug release: a novel approach for secondary cataract treatment

Tens of millions of cataract surgeries are done every year and the number is increasing heavily. Posterior capsule opacification is the major postoperative complication with an incidence of 10 to 50% within 5 years, depending on the age of the patient. We present a novel approach for secondary cataract treatment in a noninvasive manner. Photochemically triggered drug release from a polymer enables repeated drug applications for cataract treatment years after implantation of the intraocular lens, just when needed. However, light in the visible spectral range must pass through the lens but must not induce drug release. We demonstrate that two-photon absorption photochemistry is a powerful tool to overcome this problem. With wavelengths in the visible regime, a photochemical reaction that requires energies in the UV is triggered. The high intensities needed for this process never occur in any lighting condition in daily lives, but may be easily obtained with focused laser beams routinely used in ophthalmology. The properties of the therapeutic system are specified and the function is demonstrated by in-vitro cell tests. Noninvasive multidose photochemically triggered drug release from implanted intraocular lenses carrying a drug depot may be a therapeutic as well as an economic choice to established treatments of secondary cataracts.     

Mortality of HIV-positive and HIV-negative heroin abusers as a function of duration of injecting drug use

OBJECTIVE: To determine the incidence of mortality of injecting drug users as a function of the duration of injecting drugs and HIV status, and to assess how these effects vary according to age at initiation and calendar period (before and after 1992). METHODS AND DESIGN: Cohort of 376 intravenous heroin users admitted to detoxification between February 1987 and January 1990. SETTING: Patients referred from outpatient clinics of metropolitan Barcelona. Duration and characteristics of drug use were determined by interviews. Blood samples were collected during admission and analyzed for HIV, CD4+ cell count and different biologic parameters. Assessment of vital status and causes of death were obtained by hospital charts, death certificates, and autopsies. RESULTS: The study population consisted of 299 men and 77 women, whose mean age at entry was 26 years, mean duration of injecting drug use before admission 6.1 years; HIV seroprevalence at entry 70.2%. By the end of the follow-up (median 5.6 years), 21.8% of individuals had died (26.6% in HIV-positive, and 10.7% in HIV-negative injecting users). Based on Kaplan-Meier estimates, 10%, 20%, and 30% of HIV negative patients died by 8.7, 11.3 and 14.3 years, respectively, after initiating injecting drugs. The corresponding survival times for the seropositives were substantially lower: 6.6, 8.5, and 11.6 years, respectively. Overall, the survival time was significantly (p < .05) decreased by 22% in HIV-positive injecting drug users. Older age at initiation of injecting drug use was significantly (p < .05) associated with mortality in HIV-positive heroin users but it showed the opposite direction among HIV-negative people. Death rates in HIV-positive patients of the same duration of drug use were similar in periods before and after 1992 (relative hazard (RH) = 0.97; 95% confidence interval: 0.58-1.61). Although not statistically significant, the hazard of death in HIV-negative injecting drug users was substantially lower after 1992 (RH = 0.59). CONCLUSIONS: Before introduction of potent antiretroviral therapies, HIV infection further increased rates of mortality that had already been heightened by injecting drug use. Furthermore, HIV infection modifies the effect of age at initiation and eliminates the seemingly downward trend of mortality in HIV-negative people.     

Noncompliance and Drug Toxicity in Black, Poor, and Aged Patients

Drug toxicity is a common medical problem. Continued increases in drug toxicity are related to the extensive, indiscriminate use of drugs. This is a national health problem which is caused partly by gaps in pharmacology as a basic and clinical science and partly by the rapid proliferation of drugs (the drug explosion) in the past 30 years. Socioeconomically disadvantaged (black, poor, and aged) patients are particularly vulnerable to compliance problems and drug toxicity. In this presentation we discuss the basis for this increased vulnerability and suggest strategies that practicing physicians can use to minimize both compliance problems and drug toxicity.     

Childhood maltreatment and illicit drug use in middle adulthood: the role of neighborhood characteristics

This paper examined whether childhood maltreatment increases the risk of living in neighborhoods with less desirable characteristics (i.e., more disorder and disadvantage, less social cohesion, social control and advantage, and fewer resources) in middle adulthood and whether these neighborhood characteristics influence subsequent illicit drug use. Using a prospective cohort design study, court documented cases of childhood abuse and neglect and matched controls (n = 833) were first interviewed as young adults (mean age = 29 years) from 1989 to 1995 and again in middle adulthood from 2000 to 2002 (mean age = 40 years) and 2003 to 2005 (mean age = 41 years). In middle adulthood, individuals with histories of childhood abuse and neglect were more likely to live in neighborhoods with more disorder and disadvantage and less social cohesion and advantage compared to controls and to engage in illicit drug use during the past year. Path analyses showed an indirect effect on illicit drug use via neighborhood disorder among maltreated children, even after accounting for drug abuse symptoms in young adulthood, although this was sex specific and race specific, affecting women and Whites. Overall, child abuse and neglect places children on a negative trajectory that dynamically influences negative outcomes at multiple levels into middle adulthood.     

Molecular analysis of hepatitis C virus infection in Bulgarian injecting drug users

Intravenous drug users constitute a group at risk for hepatitis C virus (HCV) infection. Today, no data are available on the molecular epidemiology of HCV in Bulgaria despite the fact that in recent years the incidence of acute hepatitis C infection among Bulgarian intravenous drug users increased sixfold and about 2/3 of them developed a chronic infection. The aim of this study was to determine the circulation of hepatitis C genotypes among drug users and to study the evolution and transmission history of the virus by molecular clock and Bayesian methods, respectively. Sequencing of NS5B gene showed that the genotype 3a was the most prevalent type among intravenous drug users. In the Bayesian tree, the 3a subtypes grouped in one main clade with one small cluster well statistically supported. The root of the tree was dated back to the year 1836, and the main clade from Bulgaria was dated 1960. The effective number of infections remained constant until about years 1950s, growing exponentially from the 1960s to the 1990s, reaching a plateau in the years 2000. The not significant intermixing with isolates from other countries may suggest a segregated circulation of the epidemic between 1940s and 1980s. The plateau reached by the epidemic in the early 2000s may indicate the partial success of the new preventive policies adopted in Bulgaria.     

Studies confirm value of early and combination treatments

Studies confirm that combination drug therapy, ddI or ddC with AZT, is better than AZT monotherapy. ACTG 175 shows a 50 percent decline in progression to AIDS or death in 32 percent of the participants using AZT alone, as opposed to 18 to 22 percent of those using drug combinations with AZT. Viral load decreases were greater with AZT drug combinations than with AZT alone. In the Delta study, researchers report AZT drug combinations reduced progression to death by up to 38 percent over a period of 2 years. Patients on AZT alone had earlier deaths than those using AZT drug combinations, regardless of how early AZT treatment began.     

新生儿病房呼吸机相关性肺炎病原菌变迁及药物敏感性分析

目的探讨近年新生儿层流病房应用后新生儿呼吸机相关性肺炎（VAP）的病原菌变迁及药物敏感性情况。方法系统回顾我院新生儿重症监护病房（NICU）近4年接受机械通气〉48h的287例患儿的I临床资料,以发生时间先后分成两组,分析其VAP发病情况、痰培养病原学、药敏结果及治疗转归等。结果近4年NICU的VAP发生率为15．68％．培养出致病菌株共32株．依次为缓症链球菌、嗜麦芽窄食单胞菌、溶血葡萄球菌、肺炎克雷伯菌等。前两年病原菌以革兰阳性菌为主,主要是缓症链球菌和葡萄球菌属,近两年以革兰阴性杆菌为主,尤以嗜麦芽窄食单胞菌居多。以万古霉素、环丙沙星、氧氟沙星为主要敏感药物,对青霉素类抗生素及第二、三代头孢菌素普遍耐药。结论近年VAP致病菌谱发生显著改变,以耐药性条件致病菌为主,强调综合治疗,预防为主,尽早使用敏感药物。     

Declining drug resistance of Mycobacterium tuberculosis isolates from elderly patients in Taiwan, 2000–2008

We retrospectively investigated the prevalence of drug resistance in Mycobacterium tuberculosis (MTB) isolates recovered from elderly patients and compared the drug resistance patterns between the elderly (≥65 years old) and adult (15–64 years old) patients. Data on the prevalence of drug resistance in clinical and non-duplicate isolates of MTB recovered from 2000 to 2008 were evaluated. Among the 3,186 non-duplicate MTB isolates found during the study period, 1,497 isolates were recovered from elderly patients. Thirty-eight (2.54%) isolates were multidrug-resistant tuberculosis (MDRTB). The rates of resistance to isoniazid (INH), rifampicin (RIF), ethambutol (EMB), streptomycin (SM), ofloxacin, rifabutin, any one drug-resistant (ADR), and multidrug-resistant (MDR) were significantly lower in isolates from the elderly than from adults (p < 0.05). Significant decreasing trends in resistance rates to EMB, SM, at least any one of the four first-line agents (ADR), and MDRTB were observed (p < 0.05) . In conclusion, elderly patients had a lower rate of anti-TB drug resistance than adults and a decreasing overall trend of anti-TB drug resistance was found in the elderly in recent years, but the higher rate of MDRTB in Taiwan continues to present a challenge for the control of TB in the elderly.     

Profil épidémio-clinique des toxidermies bulleuses chez l’enfant à Abidjan (Côte d’Ivoire)

Severe cutaneous drug reactions such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life threatening in adults. They seem to be less common in children. The purpose of this study was to describe the epidemiological, clinical and etiological profile of these drug reactions in African child. It was about a retrospective study carried on for 10 years at the Dermatology center of University Hospital of Treichville, Abidjan (Cote d’Ivoire).Were included all children aged 0–15 years hospitalized for severe cutaneous drug reaction. They represented 14.1% (27 cases) with an estimated hospital rate of 0.01%. The sex ratio (M/F) was 1.2. The mean age was 10.3 years. 19 children were suffering from SJS (63%) and 9 children (33.3%) from TEN. Sulfonamides were the most commonly used drugs with sulfadoxin-pyrimethamin (25.9%), used for malariae, and cotrimoxazole (22.2%). Self-medication was practiced by 70.4% of parents. The average time to onset of lesions from drug intake was 8.2 days. Only one child was HIV infected. Three children affected by TEN (11.1%) died.     

NTZ qualifies for orphan drug status

Unimed Pharmaceuticals' nitazoxamide (NTZ) has been granted orphan drug status by the Food and Drug Administration (FDA). The designation gives the manufacturer seven years of exclusive rights to sell the drug. Nitazoxamide is used in the treatment of cryptosporidiosis, and is now in Phase II trials. The drug has proven to be safe and effective in more than 1,000 patients so far.     

Bone mineral in mentally retarded patients receiving long-term anticonvulsive therapy.

A direct photon absorptiometry method was used to measure bone mineral content in a population of mentally retarded subjects, one half of whom were undergoing long-term anticonvulsant drug therapy. The sample consisted of 134 subjects, 60 males and 74 females. Average ages were 22.5 years for the females and 19.7 years for the males. A multiple regression analysis showed there was no apparent effect on anticonvulsant drug therapy on bone mineral content in this mentally retarded and growth retarded population. A comparison with normal standards indicates that bone mineral values for age for both sexes of mentally retarded subjects were depressed from 15-40 percent relative to white standards. The bone mineral depression closely paralleled the growth depression seen in this population. It is suggested that the inability to detect an overall anticonvulsive drug effect on bone mineral values may be due to the general growth retardation seen in this institutionalized mentally retarded population.     

Prevalence and incidence of HIV among out-of-treatment injecting drug users, Chicago 1994-1996

OBJECTIVES: To assess HIV prevalence, incidence, and associated risk factors among IDUs in Chicago. METHODS: Seven hundred ninety-four street-recruited IDUs ranging in age from 18 to 50 years, who were not in drug treatment at study enrollment, were interviewed and tested for HIV at baseline and at two follow-ups scheduled 6 and 12 months after baseline. Questionnaires assessed respondents' demographic characteristics, medical and drug treatment histories, drug use, and sexual practices. RESULTS: HIV seroprevalence at baseline was 18%. Logistic regression identified the following determinants of prevalent HIV infection: Puerto Rican ethnicity, homosexual or bisexual self-identification, injecting for 4 or more years, and having smoked crack cocaine in the past 6 months. Follow-up data were collected from 584 (73.6%) participants. Mean duration of follow-up was 16.5 months, indicating that most subjects had follow-up intervals longer than the scheduled 6 and 12 months. Seven HIV seroconversions were observed in 632 person years of risk, yielding an incidence rate of 1.1 per 100 person years of risk. Injection for 3 or less years was positively associated with HIV seroconversion. CONCLUSIONS: The findings provide evidence of a decline in HIV incidence among IDUs, though newer injectors remain at elevated risk for infection.