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Opioid-Mediated HIV-1 Immunopathogenesis. J Neuroimmune Pharmacol 2020; 15:628-642. [PMID: 33029670 DOI: 10.1007/s11481-020-09960-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 09/14/2020] [Indexed: 02/07/2023]
Abstract
Despite the ability of combination antiretroviral therapy to dramatically suppress viremia, the brain continues to be a reservoir of HIV-1 low-level replication. Adding further complexity to this is the comorbidity of drug abuse with HIV-1 associated neurocognitive disorders and neuroHIV. Among several abused drugs, the use of opiates is highly prevalent in HIV-1 infected individuals, both as an abused drug as well as for pain management. Opioids and their receptors have attained notable attention owing to their ability to modulate immune functions, in turn, impacting disease progression. Various cell culture, animal and human studies have implicated the role of opioids and their receptors in modulating viral replication and virus-mediated pathology both positively and negatively. Further, the combinatorial effects of HIV-1/HIV-1 proteins and morphine have demonstrated activation of inflammatory signaling in the host system. Herein, we summarized the current knowledge on the role of opioids on peripheral immunopathogenesis, viral immunopathogenesis, epigenetic profiles of the host and viral genome, neuropathogenesis of SIV/SHIV-infected non-human primates, blood-brain-barrier, HIV-1 viral latency, and viral rebound. Overall, this review provides recent insights into the role of opioids in HIV-1 immunopathogenesis. Graphical abstract.
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Prottengeier J, Koutsilieri E, Scheller C. The effects of opioids on HIV reactivation in latently-infected T-lymphoblasts. AIDS Res Ther 2014; 11:17. [PMID: 25013451 PMCID: PMC4091651 DOI: 10.1186/1742-6405-11-17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 06/28/2014] [Indexed: 12/12/2022] Open
Abstract
Background Opioids may have effects on susceptibility to HIV-infection, viral replication and disease progression. Injecting drug users (IDU), as well as anyone receiving opioids for anesthesia and analgesia may suffer the clinical consequences of such interactions. There is conflicting data between in vitro experiments showing an enhancing effect of opioids on HIV replication and clinical data, mostly showing no such effect. For clarification we studied the effects of the opioids heroin and morphine on HIV replication in cultured CD4-positive T cells at several concentrations and we related the observed effects with the relevant reached plasma concentrations found in IDUs. Methods Latently-infected ACH-2 T lymphoblasts were incubated with different concentrations of morphine and heroine. Reactivation of HIV was assessed by intracellular staining of viral Gag p24 protein and subsequent flow cytometric quantification of p24-positive cells. The influence of the opioid antagonist naloxone and the antioxidants N-acetyl-cysteine (NAC) and glutathione (GSH) on HIV reactivation was determined. Cell viability was investigated by 7-AAD staining and flow cytometric quantification. Results Morphine and heroine triggered reactivation of HIV replication in ACH-2 cells in a dose-dependent manner at concentrations above 1 mM (EC50 morphine 2.82 mM; EC50 morphine 1.96 mM). Naloxone did not interfere with heroine-mediated HIV reactivation, even at high concentrations (1 mM). Opioids also triggered necrotic cell death at similar concentrations at which HIV reactivation was observed. Both opioid-mediated reactivation of HIV and opioid-triggered cell death could be inhibited by the antioxidants GSH and NAC. Conclusions Opioids reactivate HIV in vitro but at concentrations that are far above the plasma levels of analgesic regimes or drug concentrations found in IDUs. HIV reactivation was mediated by effects unrelated to opioid-receptor activation and was tightly linked to the cytotoxic activity of the substances at millimolar concentrations, suggesting that opioid-mediated reactivation of HIV was due to accompanying effects of cellular necrosis such as activation of reactive oxygen species and NF-κB.
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Schuster RM, Gonzalez R. Substance Abuse, Hepatitis C, and Aging in HIV: Common Cofactors that Contribute to Neurobehavioral Disturbances. ACTA ACUST UNITED AC 2012; 2012:15-34. [PMID: 24014165 DOI: 10.2147/nbhiv.s17408] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Although the prevalence of neurocognitive disturbances among individuals with HIV has decreased in recent years, rates of impairment still remain high. This review presents findings from comorbid conditions that may contribute to further neurocognitive impairments in this already vulnerable population. We will focus on three co-factors that have received substantial attention in the neuroAIDS literature: drug use, hepatitis C co-infection (HCV), and aging. All three conditions commonly co-occur with HIV and likely interact with HIV in complex ways. Collectively, the extant literature suggests that drug use, HCV, and aging serve to worsen the neurocognitive profile of HIV through several overlapping mechanisms. A better understanding of how specific comorbidities interact with HIV may reveal specific phenotypes of HIV-associated neurocognitive disorder that may aid in the development of more targeted behavioral and pharmacological treatment efforts.
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Cohn SE, Jiang H, McCutchan JA, Koletar SL, Murphy RL, Robertson KR, de St Maurice AM, Currier JS, Williams PL. Association of ongoing drug and alcohol use with non-adherence to antiretroviral therapy and higher risk of AIDS and death: results from ACTG 362. AIDS Care 2011; 23:775-85. [PMID: 21293986 DOI: 10.1080/09540121.2010.525617] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Drug and alcohol use have been associated with a worse prognosis in short-term and cross-sectional analyses of HIV-infected populations, but longitudinal effects on adherence to antiretroviral therapy (ART) and clinical outcomes in advanced AIDS are less well characterized. We assessed self-reported drug and alcohol use in AIDS patients, and examined their association with non-adherence and death or disease progression in a multicenter observational study. We defined non-adherence as reporting missed ART doses in the 48 hours before study visits. The association between drug use and ART non-adherence was evaluated using repeated measures generalized estimating equation (GEE) models. The association between drug and alcohol use and time to new AIDS diagnosis or death was evaluated via Cox regression models, controlling for covariates including ART adherence. Of 643 participants enrolled between 1997 and 1999 and followed through 2007, at entry 39% reported ever using cocaine, 24% amphetamines, and 10% heroin. Ongoing drug use during study follow-up was reported by 9% using cocaine, 4% amphetamines, and 1% heroin. Hard drug (cocaine, amphetamines, or heroin) users had 2.1 times higher odds (p=0.001) of ART non-adherence in GEE models and 2.5 times higher risk (p=0.04) of AIDS progression or death in Cox models. Use of hard drugs was attenuated as a risk factor for AIDS progression or death after controlling for non-adherence during follow-up (HR = 2.11, p=0.08), but was still suggestive of a possible adherence-independent mechanism of harm. This study highlights the need to continuously screen and treat patients for drug use as a part of ongoing HIV care.
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Affiliation(s)
- Susan E Cohn
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA.
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Ribeiro dos Santos P, Rancez M, Prétet JL, Michel-Salzat A, Messent V, Bogdanova A, Couëdel-Courteille A, Souil E, Cheynier R, Butor C. Rapid dissemination of SIV follows multisite entry after rectal inoculation. PLoS One 2011; 6:e19493. [PMID: 21573012 PMCID: PMC3090405 DOI: 10.1371/journal.pone.0019493] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Accepted: 04/06/2011] [Indexed: 12/30/2022] Open
Abstract
Receptive ano-rectal intercourse is a major cause of HIV infection in men having sex with men and in heterosexuals. Current knowledge of the mechanisms of entry and dissemination during HIV rectal transmission is scarce and does not allow the development of preventive strategies. We investigated the early steps of rectal infection in rhesus macaques inoculated with the pathogenic isolate SIVmac251 and necropsied four hours to nine days later. All macaques were positive for SIV. Control macaques inoculated with heat-inactivated virus were consistently negative for SIV. SIV DNA was detected in the rectum as early as four hours post infection by nested PCR for gag in many laser-microdissected samples of lymphoid aggregates and lamina propria but never in follicle-associated epithelium. Scarce SIV antigen positive cells were observed by immunohistofluorescence in the rectum, among intraepithelial and lamina propria cells as well as in clusters in lymphoid aggregates, four hours post infection and onwards. These cells were T cells and non-T cells that were not epithelial cells, CD68+ macrophages, DC-SIGN+ cells or fascin+ dendritic cells. DC-SIGN+ cells carried infectious virus. Detection of Env singly spliced mRNA in the mucosa by nested RT-PCR indicated ongoing viral replication. Strikingly, four hours post infection colic lymph nodes were also infected in all macaques as either SIV DNA or infectious virus was recovered. Rapid SIV entry and dissemination is consistent with trans-epithelial transport. Virions appear to cross the follicle-associated epithelium, and also the digestive epithelium. Viral replication could however be more efficient in lymphoid aggregates. The initial sequence of events differs from both vaginal and oral infections, which implies that prevention strategies for rectal transmission will have to be specific. Microbicides will need to protect both digestive and follicle-associated epithelia. Vaccines will need to induce immunity in lymph nodes as well as in the rectum.
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Affiliation(s)
- Patricia Ribeiro dos Santos
- Laboratoire de Transmission et Dissémination Virales, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Magali Rancez
- Laboratoire de Transmission et Dissémination Virales, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Jean-Luc Prétet
- Laboratoire de Transmission et Dissémination Virales, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Alice Michel-Salzat
- Laboratoire de Transmission et Dissémination Virales, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Valérie Messent
- Laboratoire de Transmission et Dissémination Virales, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Anna Bogdanova
- Laboratoire de Transmission et Dissémination Virales, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Anne Couëdel-Courteille
- Laboratoire de Transmission et Dissémination Virales, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Evelyne Souil
- Plateforme de Morpho-Histologie, Institut Cochin, INSERM U1016, CNRS URA8104, Université Paris Descartes UMR-S1016, Paris, France
| | - Rémi Cheynier
- Département d'Immunologie-Hématologie, Institut Cochin, INSERM U1016, CNRS URA8104, Université Paris Descartes UMR-S1016, Paris, France
| | - Cécile Butor
- Laboratoire de Transmission et Dissémination Virales, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
- * E-mail:
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Morphine potentiates neuropathogenesis of SIV infection in rhesus macaques. J Neuroimmune Pharmacol 2011; 6:626-39. [PMID: 21431470 DOI: 10.1007/s11481-011-9272-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Accepted: 03/07/2011] [Indexed: 10/18/2022]
Abstract
Despite the advent of antiretroviral therapy, complications of HIV-1 infection with concurrent drug abuse are an emerging problem. Opiates are well known to modulate immune responses by preventing the development of cell-mediated immune responses. Their effect on the pathogenesis of HIV-1 infection however remains controversial. Using the simian immunodeficiency virus/macaque model of HIV pathogenesis, we sought to explore the impact of morphine on disease progression and pathogenesis. Sixteen rhesus macaques were divided into two groups; four were administered saline and 12 others morphine routinely. Both groups of animals were then inoculated with SIVmacR71/17E and followed longitudinally for disease pathogenesis. The morphine group (M+V) exhibited a trend towards higher mortality rates and retardation in weight gain compared to the virus-alone group. Interestingly, a subset of M+V animals succumbed to disease within weeks post-infection. These rapid progressors also exhibited a higher incidence of other end-organ pathologies. Despite the higher numbers of circulating CD4+ and CD8+ T cells in the M+V group, CD4/CD8 ratios between the groups remained unchanged. Plasma and CSF viral load in the M+V group was at least a log higher than the control group. Similarly, there was a trend toward increased virus build-up in the brains of M+V animals compared with controls. A novel finding of this study was the increased influx of infected monocyte/macrophages in the brains of M+V animals.
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Riazi M, Marcario JK, Samson FK, Kenjale H, Adany I, Staggs V, Ledford E, Marquis J, Narayan O, Cheney PD. Rhesus macaque model of chronic opiate dependence and neuro-AIDS: longitudinal assessment of auditory brainstem responses and visual evoked potentials. J Neuroimmune Pharmacol 2009; 4:260-75. [PMID: 19283490 PMCID: PMC3713620 DOI: 10.1007/s11481-009-9149-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2008] [Accepted: 02/24/2009] [Indexed: 11/30/2022]
Abstract
Our work characterizes the effects of opiate (morphine) dependence on auditory brainstem and visual evoked responses in a rhesus macaque model of neuro-AIDS utilizing a chronic continuous drug delivery paradigm. The goal of this study was to clarify whether morphine is protective, or if it exacerbates simian immunodeficiency virus (SIV)-related systemic and neurological disease. Our model employs a macrophage tropic CD4/CCR5 coreceptor virus, SIV(mac)239 (R71/E17), which crosses the blood-brain barrier shortly after inoculation and closely mimics the natural disease course of human immunodeficiency virus infection. The cohort was divided into three groups: morphine only, SIV only, and SIV + morphine. Evoked potential (EP) abnormalities in subclinically infected macaques were evident as early as 8 weeks postinoculation. Prolongations in EP latencies were observed in SIV-infected macaques across all modalities. Animals with the highest cerebrospinal fluid viral loads and clinical disease showed more abnormalities than those with subclinical disease, confirming our previous work (Raymond et al., J Neurovirol 4:512-520, 1998; J Neurovirol 5:217-231, 1999; AIDS Res Hum Retroviruses 16:1163-1173, 2000). Although some differences were observed in auditory and visual evoked potentials in morphine-treated compared to morphine-untreated SIV-infected animals, the effects were relatively small and not consistent across evoked potential type. However, morphine-treated animals with subclinical disease had a clear tendency toward higher virus loads in peripheral and central nervous system tissues (Marcario et al., J Neuroimmune Pharmacol 3:12-25, 2008) suggesting that if had been possible to follow all animals to end-stage disease, a clearer pattern of evoked potential abnormality might have emerged.
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Affiliation(s)
- Mariam Riazi
- Department of Molecular & Integrative Physiology, University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66160 USA
| | - Joanne K Marcario
- Department of Molecular & Integrative Physiology, University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66160 USA
| | - Frank K. Samson
- Department of Molecular & Integrative Physiology, University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66160 USA
| | - Himanshu Kenjale
- Department of Microbiology, Molecular Genetics & Immunology, University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66160 USA
| | - Istvan Adany
- Department of Microbiology, Molecular Genetics & Immunology, University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66160 USA
| | - Vincent Staggs
- Research Design & Analysis Unit of the Schiefelbusch Institute for Lifespan Studies, University of Kansas, 1000 Sunnyside Ave., Lawrence, KS 66045, USA
| | - Emily Ledford
- Research Design & Analysis Unit of the Schiefelbusch Institute for Lifespan Studies, University of Kansas, 1000 Sunnyside Ave., Lawrence, KS 66045, USA
| | - Janet Marquis
- Research Design & Analysis Unit of the Schiefelbusch Institute for Lifespan Studies, University of Kansas, 1000 Sunnyside Ave., Lawrence, KS 66045, USA
| | - Opendra Narayan
- Department of Microbiology, Molecular Genetics & Immunology, University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66160 USA
| | - Paul D. Cheney
- Department of Molecular & Integrative Physiology, University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66160 USA
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Probable deceleration of progression of Simian AIDS affected by opiate dependency: studies with a rhesus macaque/SIVsmm9 model. J Acquir Immune Defic Syndr 2009; 50:241-9. [PMID: 19194320 DOI: 10.1097/qai.0b013e3181967354] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine effects of opiate dependency on development of simian AIDS. DESIGN Assessments of viral, immune, and clinicopathological status were conducted on rhesus macaques before and after establishment of opiate dependency and Simian Immunodeficiency Virus, sooty mangabey, strain-9 (SIVsmm9) infection. Controls received saline. METHODS Blood was collected at baseline, before opiate dependencies, and viral infections were established and then after SIVsmm9 infection, longitudinally, through 216 weeks. Plasma viral titers were assessed using the branched chain DNA assay and CD4 and CD8 counts via cytofluorometry. Clinicopathological assessments of AIDS were founded on Centers for Disease Control and Prevention and other selected criteria. RESULTS AIDS progression rates seemed to be decelerated and survival times increased by opiate dependency. Mean viral titers were unaffected by opiate exposure. Opiate-dependent monkeys that evidenced high initial viral titers survived significantly longer than controls. Several opiate-dependent monkeys maintained high viral titers for atypically extended durations. Several (5/19) opiate-dependent monkeys died or were removed early from the study due to "non-AIDS" causes. CONCLUSIONS Long-term opiate dependency seemed to decelerate the rate of progression to AIDS in the SIVsmm9 monkey model. This effect was most evident in monkeys with high initial viral titers/set points. "Non-AIDS" morbidities and mortalities were noted as potential confounds of epidemiological assessments of the role of opiates in HIV/AIDS.
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Lucas GM, Griswold M, Gebo KA, Keruly J, Chaisson RE, Moore RD. Illicit drug use and HIV-1 disease progression: a longitudinal study in the era of highly active antiretroviral therapy. Am J Epidemiol 2006; 163:412-20. [PMID: 16394200 DOI: 10.1093/aje/kwj059] [Citation(s) in RCA: 143] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study assessed the association between longitudinal patterns of illicit drug use and clinical progression of human immunodeficiency virus (HIV) disease. Confidential computer-based interviews, which addressed illicit drug use and other factors, were completed by HIV-infected participants in Baltimore, Maryland, at 6-month intervals from 1998 onward. To assess this association, the authors used a random-effects model in which clinically defined opportunistic conditions were linked to self-reported periods of drug use, enabling four categories of drug use to be distinguished: nonusers, intermittent users during abstinent periods, intermittent users during active periods, and persistent users. Included in the analysis were 1,851 participants who completed > or = 1 survey. For participants who used drugs intermittently over time, the risk of developing new opportunistic conditions during periods of abstinence was similar to that for those who never used drugs (odds ratio = 1.2, 95% confidence interval: 0.9, 1.7). In contrast, compared with that for nonusers, the risk of opportunistic infection was significantly higher for intermittent drug users during periods of active use (odds ratio = 2.2, 95% confidence interval: 1.4, 2.9) and for persistent drug users (odds ratio = 1.9, 95% confidence interval: 1.2, 2.8). Active drug use is temporally linked to HIV disease progression and mortality. Effectively targeting and treating active substance abuse in HIV treatment settings may provide a mechanism to improve clinical outcomes.
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Affiliation(s)
- Gregory M Lucas
- Division of Infectious Diseases, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Thorpe LE, Frederick M, Pitt J, Cheng I, Watts DH, Buschur S, Green K, Zorrilla C, Landesman SH, Hershow RC. Effect of hard-drug use on CD4 cell percentage, HIV RNA level, and progression to AIDS-defining class C events among HIV-infected women. J Acquir Immune Defic Syndr 2005; 37:1423-30. [PMID: 15483472 DOI: 10.1097/01.qai.0000127354.78706.5d] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In vitro and animal studies suggest that cocaine and heroin increase HIV replication and suppress immune function, whereas epidemiologic studies are inconclusive regarding their effect on HIV infection progression. The authors prospectively examined the association between illicit-drug use and 4 outcome measures (CD4 cell percentage, HIV RNA level, survival to class C diagnosis of HIV infection, and death) in a national cohort of HIV-infected women. Women enrolled between 1989 and 1995 were followed for 5 years and repeatedly interviewed about illicit ("hard")--drug use. Up to 3 periodic urine screens validated self-reported use. Outcomes were compared between hard-drug users (women using cocaine, heroin, methadone, or injecting drugs) and nonusers, adjusting for age, antiretroviral therapy, number of pregnancies, smoking, and baseline CD4 cell percentage. Of 1148 women, 40% reported baseline hard-drug use during pregnancy. In multivariate analyses, hard-drug use was not associated with change in CD4 cell percentage (P = 0.84), HIV RNA level (P = 0.48), or all-cause mortality (relative hazard = 1.10; 95% confidence interval, 0.61-1.98). Hard-drug users did, however, exhibit a higher risk of developing class C diagnoses (relative hazard = 1.65; 95% confidence interval, 1.00-2.72), especially herpes, pulmonary tuberculosis, and recurrent pneumonia. Hard-drug-using women may have a higher risk for nonfatal opportunistic infections.
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Affiliation(s)
- Lorna E Thorpe
- New York City Department of Health and Mental Hygiene, New York, NY, USA.
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Abstract
Whether opiates and other drugs of abuse affect AIDS progression has been an unresolved issue for two decades. Credible evidence has suggested that opiates may exacerbate, retard or have 'no effect' on progression of AIDS. Differences may exist in AIDS-progression outcomes after opiate exposures that relate to neural versus, strictly, somatic AIDS; but it is also likely that conditional variables inherent to drug dependency and the nature of the infectious agents involved allow for differing outcomes. Data from epidemiological studies, and from in vitro and basic immunological studies regarding opiate effects on AIDS progression must be interpreted in light of the conditionality of opiate effects. Caution is sounded, also, about interpreting common depressive immunological effects of opiates as indicators of influence over AIDS progression. Current evidence from the monkey model of AIDS indicates that opiates can, under certain defined conditions, retard AIDS progression. The clinical relevance of these data remains to be defined. Importantly, such data imply that opioids and the endogenous opioid system may represent therapeutic tools and targets for altering AIDS progression.
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Affiliation(s)
- Robert M Donahoe
- Department of Psychiatry and Behavioral Sciences, Emory University, School of Medicine, Briarcliff Campus, Atlanta, GA 30306, USA.
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Barr MC, Huitron-Resendiz S, Sanchez-Alavez M, Henriksen SJ, Phillips TR. Escalating morphine exposures followed by withdrawal in feline immunodeficiency virus-infected cats: a model for HIV infection in chronic opiate abusers. Drug Alcohol Depend 2003; 72:141-9. [PMID: 14636969 DOI: 10.1016/s0376-8716(03)00195-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Opiate abuse is a risk factor for human immunodeficiency virus (HIV) infection. Because the direct effects of opiates on HIV infection are difficult to determine epidemiologically, animal models of lentivirus infection are relied upon to study the effects of opiates in the absence of confounding factors. Morphine, the predominant metabolite of heroin, is used in most experimental systems examining heroin abuse. In this study, morphine treatment of feline immunodeficiency virus (FIV)-infected cats modeled a typical pattern of escalating drug use interspersed with withdrawals. Plasma cortisol levels were measured for evidence of stress associated with morphine withdrawal. In the morphine-treated cats, cortisol levels peaked at time points corresponding to morphine withdrawal and returned to baseline levels during treatment and several weeks after the final withdrawal. Morphine-treated cats displayed clear behavioral and physical signs of opiate exposure and evidence of withdrawal when the drug was stopped. Morphine-exposed cats did not experience enhanced severity of FIV-related disease; in fact, morphine demonstrated a protective effect on FIV-associated changes in brainstem auditory evoked potentials. Our research suggests that opiate exposure is unlikely to adversely affect the progression of acute lentivirus infection and might be beneficial in controlling associated neurological disease.
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Affiliation(s)
- Margaret C Barr
- Vaccine Research Institute of San Diego, 3030 Bunker Hill St., San Diego, CA 92109, USA
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Improved methods and assumptions for estimation of the HIV/AIDS epidemic and its impact: Recommendations of the UNAIDS Reference Group on Estimates, Modelling and Projections. AIDS 2002; 16:W1-14. [PMID: 12045507 DOI: 10.1097/00002030-200206140-00024] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNAIDS and WHO produce biannual country-specific estimates of HIV/AIDS and its impact. These estimates are based on methods and assumptions that reflect the best understanding of HIV epidemiology and demography at the time. Where significant advances are made in epidemiological and demographic research, the methods and assumptions must evolve to match these advances. UNAIDS established an Epidemiology Reference Group in 1999 to advise them and other organisations on HIV epidemiology and methods for making estimates and projections of HIV/AIDS. During the meeting of the reference group in 2001, four priority areas were identified where methods and assumptions should be reviewed and perhaps modified: a) models of the HIV epidemic, b) survival of adults with HIV-1 in low and middle income countries, c) survival of children with HIV-1 in low and middle income countries, and d) methods to estimate numbers of AIDS orphans. Research and literature reviews were carried out by Reference Group members and invited specialists, prior to meetings held during 2001-2. Recommendations reflecting the consensus of the meeting participants on the four priority areas were determined at each meeting. These recommendations were followed in UNAIDS and WHO development of country-specific estimates of HIV/AIDS and its impact for end of 2001.
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Homan JW, Steele AD, Martinand-Mari C, Rogers TJ, Henderson EE, Charubala R, Pfleiderer W, Reichenbach NL, Suhadolnik RJ. Inhibition of morphine-potentiated HIV-1 replication in peripheral blood mononuclear cells with the nuclease-resistant 2-5A agonist analog, 2-5A(N6B). J Acquir Immune Defic Syndr 2002; 30:9-20. [PMID: 12048358 DOI: 10.1097/00042560-200205010-00002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Opioids potentiate HIV-1 infection in vitro at least partly by suppressing immunoresponsive processes in human lymphocytes and monocytes. For example, it appears that morphine inhibits the interferon (IFN)-alpha, -beta, and -gamma-mediated natural antiviral defense pathways in human peripheral blood mononuclear cells (PBMC). In this study, we show that restoration of a key component of the antiviral pathway reverses morphine-potentiated HIV-1 infection of human PBMC. The data show that HIV-1 replication is potentiated and RNase L activity is inhibited after morphine administration. Because HIV-1 inhibits the antiviral pathway at the level of 2',5'-oligoadenylate (2-5A) synthetase and p68 kinase, antiviral enzymes that require double-stranded RNA, we overcame this blockade by the addition of the nuclease-resistant, nontoxic 2-5A agonist, 2-5A(N6B), to PBMC in culture. Addition of 2-5A(N6B), but not zidovudine or saquinavir, to morphine-treated PBMC completely reversed the morphine-induced potentiation of HIV-1 infection. Further, 2-5A(N6B) significantly enhanced expression of both IFN-alpha and IFN-gamma. Also, increased expression of IFN-gamma was associated with a significant increase in expression of RANTES and monocyte chemotactic protein (MCP)-1, chemokines that may inhibit HIV-1 infection by blocking viral attachment to CCR2 and CCR5 co-receptors. Our results suggest that reactivation of the antiviral pathway by 2-5A agonists may be useful to inhibit opioid-potentiated HIV-1 replication.
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Affiliation(s)
- Joseph W Homan
- Department of Biochemistry, Temple University School of Medicine, Philadelphia, Pennsylvania 19140, USA
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Bull SS, Piper P, Rietmeijer C. Men who have sex with men and also inject drugs-profiles of risk related to the synergy of sex and drug injection behaviors. JOURNAL OF HOMOSEXUALITY 2002; 42:31-51. [PMID: 12066991 DOI: 10.1300/j082v42n03_03] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVES Men who have sex with men and also inject drugs (MSM-IDU) are among the groups at highest risk for acquiring and transmitting HIV in Colorado and the US. We conducted formative research and a survey among MSM-IDU in Denver to better understand sexual and drug HIV risk behaviors and how they interact. METHODS Formative data were collected with 30 persons who work, live or otherwise interact with MSM-IDU using a semi-structured interview instrument. Survey data on sexual and drug risk behaviors were collected with 100 MSM-IDU; eligible participants have had sex with men and injected drugs within the past six months. RESULTS Results from formative research were used to generate the survey instrument. The survey results demonstrate high-risk sexual behaviors with multiple partners of both genders; 82% of the sample had primary and non-primary male partners, 20% had non-primary female partners, and 15% exchanged money or drugs for sex. Condom use was inconsistent and infrequent for all types of sex (vaginal, anal and oral) and with all types of partners. Drug risk behaviors highlight that the injection drugs of choice for this sample (90% shoot cocaine and 59% shoot methamphetamine) stimulate sexual desire and cocaine injection increases opportunities for injection risk behavior. Forty-five percent of the sample were HIV-infected. Significant differences between HIV infected and non-infected men were not observed with regard to many sexual and drug risk behaviors. CONCLUSIONS These data show that MSM-IDU are engaging in multiple risk behaviors that may have a synergistic effect on HIV transmission, and that their injection drug of choice contributes to their risk. That there do not appear to be consistent differences in preventive behaviors between men with or without HIV infection suggests a greatly increased risk for HIV transmission in this group of men and their partners. Because MSM-IDU do not identify strongly with either MSM because they may not gay identify or IDU because they do not use heroin, targeted HIV prevention strategies for this group are urgently needed.
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17
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Geskus RB. Methods for estimating the AIDS incubation time distribution when date of seroconversion is censored. Stat Med 2001; 20:795-812. [PMID: 11241577 DOI: 10.1002/sim.700] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
In most cohort studies on HIV infection and AIDS, data on time from seroconversion to AIDS or death are doubly censored, both at the time origin and at the endpoint of interest. In epidemiological research, the most frequently adopted approach is to restrict the analysis to persons with narrow seroconversion intervals and to impute the midpoint of this interval as date of seroconversion. For many cohort studies, the consequence is that a substantial proportion of the data is not used. We consider four methods that are expected to be less biased when all cohort data are used: two imputation methods, conditional mean and multiple imputation, and two likelihood maximization methods. We derive the likelihood structure of the cohort data and clarify its dependence on study design. All methods are applied to data from the Amsterdam cohort study among injection drug users. In a simulation study the data generation process of this cohort study is imitated. The performance of midpoint, conditional mean and multiple imputation are compared. With midpoint imputation, both an analysis using the full data set, as well as one restricted to the cases with small seroconversion intervals, is performed. Conditional mean imputation comes out as the preferred method. It gives best results with respect to mean squared error. Moreover, when confidence intervals are computed through standard methods that ignore the uncertainty in the imputed date of seroconversion, coverage probabilities are almost correct.
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Affiliation(s)
- R B Geskus
- Municipal Health Service, Division of Public Health and Environment, Nieuwe Achtergracht 100, 1018 WT, Amsterdam, The Netherlands.
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Prins M, Sabin CA, Lee CA, Devereux H, Coutinho RA. Pre-AIDS mortality and its association with HIV disease progression in haemophilic men, injecting drug users and homosexual men. AIDS 2000; 14:1829-37. [PMID: 10985321 DOI: 10.1097/00002030-200008180-00019] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To study pre-AIDS mortality and its association with HIV disease progression in different exposure groups with known intervals of HIV seroconversion. DESIGN AND METHODS The type and rate of pre-AIDS deaths were assessed in 111 HIV-infected haemophilic men followed in London, and 118 injecting drug users and 158 homosexual men followed in Amsterdam. In each group, the association between CD4+ T-cell count, HIV RNA and pre-AIDS mortality was studied using proportional hazards analysis. RESULTS By 10 years after seroconversion 7.3% of the haemophilic men had died without AIDS and 38.2% had developed AIDS. These figures were 20.2 and 30.5% for injecting drug users, and 8.0 and 55.0% for homosexual men. The major causes of pre-AIDS mortality appear to differ in the three exposure groups. The risk of pre-AIDS death tended to increase with decreasing CD4 cell count and increasing HIV RNA levels in injecting drug users and homosexual men. In men with haemophilia the associations were less obvious, although the log-transformed CD4 cell count was predictive for pre-AIDS death. CONCLUSIONS Pre-AIDS deaths occur and are at least partially related to HIV disease progression irrespective of how individuals became infected. Because of the longer life expectancy due to highly active antiretroviral therapy (HAART), pre-AIDS deaths are likely to show a further increase. Methods to incorporate these intermediate outcomes should be considered in the estimation of the size of the HIV epidemic and in the survival analysis of HIV-infected individuals. Prevention and treatment of non-AIDS infections, especially hepatitis C virus infection, and cancers will become increasingly important in HIV-infected individuals. The interaction between these therapies and HAART should be closely monitored.
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Affiliation(s)
- M Prins
- Municipal Health Service, Division of Public Health and Environment, Amsterdam, The Netherlands.
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19
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Nelson CJ, How T, Lysle DT. Enhancement of the contact hypersensitivity reaction by acute morphine administration at the elicitation phase. Clin Immunol 1999; 93:176-83. [PMID: 10527694 DOI: 10.1006/clim.1999.4783] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The present study investigated the effects of morphine on the irritant contact sensitivity (ICS) and contact hypersensitivity (CHS) reaction. ICS was induced by croton oil application on the pinnae of naïve rats. Morphine injected prior to croton oil application did not affect the ICS response when assessed by measurements of pinnae thickness. CHS was induced by applying the antigen 2,4-dinitro-1-fluorobenzene (DNFB) to the pinnae of rats sensitized to DNFB. Rats received an injection of morphine prior to either initial antigen exposure (sensitization) or antigen reexposure (challenge). Morphine prior to challenge, but not sensitization, resulted in a pronounced enhancement of the CHS response as measured by pinna thickness. Quantitative PCR also showed increased IFN-gamma mRNA levels in the inflamed tissue of morphine-treated rats. Naltrexone blocked the morphine-induced enhancement of the CHS response. The differential effects of morphine suggest that opioids have a more pronounced effect on in vivo immune responses that involve immunological memory.
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Affiliation(s)
- C J Nelson
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA.
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Pérez-Hoyos S, Aviñó M, Hernández I, González J, Ruiz I. [AIDS-free time and survival of an injecting drug users HIV seroconvertors cohort]. GACETA SANITARIA 1999; 13:337-45. [PMID: 10564846 DOI: 10.1016/s0213-9111(99)71384-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To analyze AIDS free time, survival and the pre-AIDS survival for a injecting drug users cohort (IDU) of HIV seroconvertors. SUBJECT AND METHODS Interval for seroconversion was available for 276 IDUs from Centers for AIDS Information and Prevention (CIPS) recruited between 1987 and until June of 1996. AIDS diagnosis and vital status dates were obtained by follow up at hospitals, mortality and AIDS registries, and CIPS visits. The end of follow up was December of 1996. Seroconversion date was estimated as the middle point between last HIV- and first HIV+. Kaplan-Meier extension and Cox regression for truncated data were fitted to estimate AIDS-free and survival times and to observe differences by sex, age consumption time and year of seroconversion. Weibull, and Log-normal parametric models were fitted to estimate median and percentiles of AIDS-free and survival times distribution. RESULTS 34 cases have been identified as AIDS, 24 as deaths, 9 of them being before AIDS. 63.5% of the individuals were AIDS-free 7 years after seroconversion, and the probability of death was 25.50. Pre-AIDS mortality is around 8.7%. There were not significant differences by sex, age, consumption time and year of seroconversion. Log-normal model fitted better estimating an AIDS-free median time of 10.93 years and 13.67 survival years. CONCLUSION The incubation period of HIV infection in a cohort of seroconvertors in our environment was around 11 years, not different from that observed out of the Mediterranean area as Holland, Scotland or United States
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Affiliation(s)
- S Pérez-Hoyos
- Institut Valencià d'Estudis en Salut Pública, València, 46017, España.
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Krol A, Flynn C, Vlahov D, Miedema F, Coutinho RA, van Ameijden EJ. New evidence to reconcile in vitro and epidemiologic data on the possible role of heroin on CD4+ decline among HIV-infected injecting drug users. Drug Alcohol Depend 1999; 54:145-54. [PMID: 10217554 DOI: 10.1016/s0376-8716(98)00158-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Long-term effects of drug type and other drug use related risk factors on CD4+ cell decline were assessed in 224 HIV-infected injecting drug users (IDUs) from Baltimore (ALIVE), USA, and 63 IDUs from Amsterdam, The Netherlands. Higher frequencies of borrowing used injection equipment since 1980 resulted in a higher CD4+ count already present before seroconversion (P = 0.049). Use of mainly heroin in the seroconversion interval resulted in a sharper CD4+ decline until the first 6 months after seroconversion (P = 0.004), but CD4+ values converged later on. This finding might reconcile earlier discordant epidemiological and laboratory study results regarding the possible effects of heroin.
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Affiliation(s)
- A Krol
- Division of Public Health and Environment, Municipal Health Service, Amsterdam, The Netherlands
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22
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Pezzotti P, Galai N, Vlahov D, Rezza G, Lyles CM, Astemborski J. Direct comparison of time to AIDS and infectious disease death between HIV seroconverter injection drug users in Italy and the United States: results from the ALIVE and ISS studies. AIDS Link to Intravenous Experiences. Italian Seroconversion Study. JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES AND HUMAN RETROVIROLOGY : OFFICIAL PUBLICATION OF THE INTERNATIONAL RETROVIROLOGY ASSOCIATION 1999; 20:275-82. [PMID: 10077177 DOI: 10.1097/00042560-199903010-00010] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare the rate of HIV disease progression in a sample of polydrug injectors (AIDS Link to Intravenous Experiences [ALIVE] study) with that in a sample of predominantly opiate injectors (Italian Seroconversion Study [ISS]). DESIGN Prospective cohort studies of HIV-positive individuals whose date of seroconversion (SC) is known with a good degree of precision. The ALIVE study involves a community-based cohort of injection drug users (IDU) in the United States and the ISS reports on a clinic-based cohort of seroconverters in Italy with different exposure modalities to HIV. METHODS Data from the two cohorts were combined. The date of SC was estimated as the midpoint in time between the last negative and the first positive HIV test. Time-to-event (i.e., AIDS or death from an infectious disease) statistical methods were used. Relative hazards (RH) of progression to event were adjusted by age at SC, gender, and year of SC. RESULTS Of the 1003 IDUs (251 from ALIVE and 752 from ISS), 226 progressed to AIDS, and 146 died after AIDS or from an infectious disease; of these, 10 were without an AIDS diagnosis. The two groups of IDUs differed in terms of age at SC (median, 35 years for ALIVE and 25 years for ISS), proportion of women (24% versus 31%), race (7.6% versus 100% white), and year of seroconversion (i.e., ISS participants seroconverted, on average, earlier than ALIVE participants). Although the univariate analysis suggested possible differences for progression to AIDS, or to death from infectious disease between cohorts, multivariate analyses that adjusted for age showed no significant differences by cohort, gender, race, or time of seroconversion. The median time to AIDS for 25-year-old persons was 12.3 years for ALIVE and 11.8 years for ISS; for 35-year-old persons, it was 8.5 and 8.2 years, respectively. These estimates were similar to those for non-IDUs observed in the ISS and to those from large cohort of homosexual men. CONCLUSION Our results confirm the importance of accounting for age when considering the incubation period for HIV infection. Despite differences in drug use characteristics, the similar median times to AIDS, for each age, between the two cohorts of IDUs and between the IDUs and the non-IDUs suggest a negligible effect of injection drug use on HIV progression.
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Affiliation(s)
- P Pezzotti
- Centro Operativo AIDS, Istituto Superiore di Sanità, Rome, Italy.
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23
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Kassa E, Rinke de Wit TF, Hailu E, Girma M, Messele T, Mariam HG, Yohannes S, Jurriaans S, Yeneneh H, Coutinho RA, Fontanet AL. Evaluation of the World Health Organization staging system for HIV infection and disease in Ethiopia: association between clinical stages and laboratory markers. AIDS 1999; 13:381-9. [PMID: 10199229 DOI: 10.1097/00002030-199902250-00011] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To study the association between the clinical axis of the World Health Organization (WHO) staging system of HIV infection and disease and laboratory markers in HIV-infected Ethiopians. DESIGN Cross-sectional study. METHODS Clinical manifestations and stage of HIV-positive individuals participating in a cohort study of HIV infection progression, and of HIV-positive patients hospitalized with suspicion of AIDS, were compared to CD4+ T-cell count and viral load. RESULTS Of the 86 HIV-positive participants of the cohort study, 53 (62%), 16 (19%), 16 (19%), and one (1.2%) were in stage 1, 2, 3 and 4, respectively. Minor weight loss (n = 15) and pulmonary tuberculosis (n = 9) were the most commonly diagnosed conditions among the 38 (44%) symptomatic HIV-positive individuals. Although 23 (27%) HIV-positive participants had CD4+ T-cell counts less than 200 x 10(6)/l, only one was in clinical stage 4. Among 79 hospitalized HIV-positive patients, 15 (19%) and 64 (81%) were in stage 3 and 4, respectively. The majority (83.5%) had CD4+ T-cell counts < 200 x 10(6)/l. Individuals at stage 3 had lower CD4+ T-cell counts and higher viral loads when seen in hospital as compared to cohort participants (P = 0.06 and 0.008, respectively). When grouping the two study populations, the median CD4+ T-cell count decreased (337, 262, 225, 126, and 78 x 10(6)/l, P< 0.01), and the median viral load increased (4.08, 3.89, 4.47, 5.65, and 5.65 log10 copies/ml, P < 0.01), with increasing clinical stage of HIV infection (1, 2, 3 cohort, 3 hospital, and 4, respectively). Median CD4+ T-cell counts were remarkably low in HIV-negative participants (749 x 10(6)/l), and in HIV-positive participants at stage 1 and 2 (337 and 262 x 10(6)/l, respectively). CONCLUSIONS There was a good correlation between WHO clinical stages and biological markers. CD4+ T-cell counts were low in Ethiopians, particularly during early stages of HIV-1 infection, and preliminary reference values at different stages of HIV-1 infection were determined. In HIV-infected Ethiopians, lymphocyte counts less than 1,000 x 10(6)/l in non-hospitalized individuals, and less than 2,000 x 10(6)/l in hospitalized patients, had high positive predictive value, but low sensitivity, in identifying subjects with low CD4+ T-cell counts (< 200 x 10(6)/l) who would benefit from chemoprophylaxis of opportunistic infections. The on-going longitudinal study will be useful to confirm the prognostic value of the WHO staging system.
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Affiliation(s)
- E Kassa
- Ethiopian-Netherlands AIDS Research Project, Ethiopian Health and Nutrition Research Institute, Addis Abeba
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Lyles CM, Graham NM, Astemborski J, Vlahov D, Margolick JB, Saah AJ, Farzadegan H. Cell-associated infectious HIV-1 viral load as a predictor of clinical progression and survival among HIV-1 infected injection drug users and homosexual men. Eur J Epidemiol 1999; 15:99-108. [PMID: 10204638 DOI: 10.1023/a:1007556327269] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Cell-associated infectious HIV-1 viral load was measured using semi-quantitative microculture techniques to determine its predictive capability for progression to AIDS or survival among HIV-1 infected injecting drug users (IDU) and homosexual men (HM). The authors followed 296 IDU and 240 HM from February 1992 through September 1995 for: (i) death, (ii) AIDS, and (iii) AIDS or bacterial infection. At baseline, viral load was quantified using microculture techniques to determine infectious units per million peripheral blood mononuclear cells (IUPM). Data were analyzed using standard statistical methods for survival analysis. Of the 536 total participants, 106 died (20%), and 98 of the 481 AIDS-free participants developed AIDS (20%). The relative hazard of AIDS for a viral load of > or = 100 IUPM, relative to a negative culture (0 IUPM), was 6.73 (95% CI: 2.23-20.3) after adjusting for risk group, initial CD4+ count, and other covariates. The adjusted relative hazard of death for a viral load of > or = 100 IUPM vs. 0 IUPM was 2.57 (95% CI: 0.97 6.80). Viral load predicted time to death within the < 200 cells/ul CD4+ stratum. The predictive value of viral load on HIV-1 progression did not vary by risk group. These data show that cell associated infectious HIV-1 viral load was significantly predictive of progression across risk groups for AIDS and death among those severely immune compromised.
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Affiliation(s)
- C M Lyles
- The Department of Epidemiology, The Johns Hopkins School of Hygiene and Public Health, Baltimore, Maryland, USA.
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Lyles CM, Vlahov D, Farzadegan H, Astemborski J, Margolick JB, Masters BA, Schroeder J, Quinn TC. Comparison of two measures of human immunodeficiency virus (HIV) type 1 load in HIV risk groups. J Clin Microbiol 1998; 36:3647-52. [PMID: 9817889 PMCID: PMC105256 DOI: 10.1128/jcm.36.12.3647-3652.1998] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Levels of viral burden were compared across risk group and gender populations among 485 human immunodeficiency virus type 1 (HIV-1)-infected participants consisting of 190 male injection drug users (IDUs), 92 female IDUs, and 203 homosexual men. Viral burden was quantified by a microculture technique to determine cell-associated infectious units per 10(6) peripheral blood mononuclear cells (IUPM) and by reverse transcriptase PCR (Amplicor) to determine plasma HIV RNA levels. Adjusting for CD4(+) cell count, females had a lower infectious HIV load than all males combined (0. 33 log10 lower; P = 0.004), and homosexual men had a 0.29 log10 higher infectious viral load than all IDUs combined (P = 0.001). For HIV RNA levels, females had lower levels than males (0.19 log10 lower; P = 0.04), but no differences were observed by risk group. After controlling for percent CD4(+) cells, no differences were found by risk group for either assay, but females still had a 0.25 log10 lower infectious viral load than males (P = 0.04) and a viral RNA load similar to that of males (P = 0.25). The correlation between infectious viral load and HIV RNA load was 0.58 overall, which did not differ by gender or risk group. Our data suggest that differences in viral load may exist by gender and that any differences observed by risk group are driven predominantly by gender or percent CD4(+) cell differences. These data also confirm a moderate correlation between cell-associated infectious viral load and plasma HIV RNA load, which appears to be similar by gender and across risk groups.
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Affiliation(s)
- C M Lyles
- Departments of Epidemiology, The Johns Hopkins School of Hygiene and Public Health, Baltimore, Maryland, USA.
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Houweling H, Heisterkamp SH, Wiessing LG, Coutinho RA, van Wijngaarden JK, Jager HJ. Methods for estimating HIV prevalence: A comparison of extrapolation from surveys on infection rate and risk behaviour with back-calculation for the Netherlands. Eur J Epidemiol 1998; 14:645-52. [PMID: 9849824 DOI: 10.1023/a:1007495607520] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To compare HIV prevalence estimates (total number infected) by using extrapolation from surveys on infection rate and risk behaviour (EIR) in specific segments of the population and back-calculation (BC) on reported AIDS cases. To discuss potential sources of bias and error, and to identify areas for improvement of the methodology. DESIGN Systematic comparison and epidemiological assessment of data input, underlying assumptions, and output. METHODS Low, possibly unbiased and high estimates of HIV prevalence as of January 1996 for homo/bisexual men, injecting drug users. heterosexual men and women with multiple partners, and blood transfusion recipients and haemophiliacs were derived from surveys and continuous data collections on HIV infection rate and risk behaviour in the Netherlands between 1992 and 1996. These were compared with estimates (point and 95 % CI) by empirical Bayesian BC on AIDS cases 1982-1995. RESULTS AND CONCLUSIONS The estimate of HIV prevalence by EIR was 13,806 with low and high estimates of 9619 and 17,700, respectively. The HIV prevalence estimate by BC was 8812 (95% CI: 7759-9867). The available data from EIR are too limited for accurate estimates of HIV prevalence. EIR estimates could be improved considerably with more precise data on prevalence of risk behaviours and HIV prevalence rate for homosexual men. More confidence can be put in the BC estimates, but these could be underestimates because of the age effect on incubation time, pre-AIDS treatment and relapse of risk behaviour. BC estimates could be improved by a better representation of the incubation time distribution (including the effect of age there-upon), better data on the effectiveness and uptake of pre-AIDS antiretroviral treatment and prophylaxis of opportunistic infections, and on the level of underreporting.
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Affiliation(s)
- H Houweling
- Department of Infectious Diseases Epidemiology, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
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Abstract
Because of the widely documented association of AIDS with opiate abuse, there is considerable interest in knowing whether opiates alter progression of HIV-1 infections to AIDS. The main reason for this interest is that opiates and opiate-abuse have been shown to have broad influence on immune processes as well as in vitro expressions of HIV-1. This article reviews literature defining the connection between opiate use and AIDS. Basic understanding of the effects of opiates on immune process and HIV-1 infection, especially as derived from study of a monkey model of AIDS, are discussed as well as epidemiological data regarding the connection between chronic injected drug abuse and AIDS, in the context of current knowledge about the HIV-1 infectious process and AIDS pathogenesis. Theoretically, there is ample reason to suspect that opiates are involved in progression of HIV-1 infections to AIDS. To date, however, epidemiological approaches have been unable to link decline in CD4 T-cell counts, as a marker of AIDS progression, with opiate use--although other indices of AIDS progression have yet to be thoroughly evaluated in this regard. Also, the impact of opiate use and abuse on opportunistic infections occurring prior to or concurrent with HIV-1 infection has not been closely scrutinized. Interestingly, despite considerable evidence delineating the potential of opiates to exacerbate HIV-1 infections, there is suggestive evidence from both clinical observations and basic studies that homeostatically balancing conditions of chronic, consistent opiate exposure have the potential to protect the host from progression of HIV-1 infections--a situation that may well differ from when opiate-naive subjects first experience exposure to opiates and when opiate dependency is not maintained in a consistent fashion. Taken together, therefore, information from basic studies, including most particularly studies with monkeys, and epidemiological studies, indicates that effects of opiates on progression to AIDS may be conditionally variable. There are many aspects of the drug abuse culture that have potentially offsetting consequences in terms of their potential to up- or down-regulate both HIV-1 expression and host protective responses thereto that could be relevant in this regard. In conclusion, many ambiguities are yet to be considered, and basic and epidemiological studies to be pursued before the opiate-AIDS connection is fully understood.
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Affiliation(s)
- R M Donahoe
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Georgia Mental Health Institute, Atlanta 30322, USA
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Prins M, Veugelers PJ. Comparison of progression and non-progression in injecting drug users and homosexual men with documented dates of HIV-1 seroconversion. European Seroconverter Study and the Tricontinental Seroconverter Study. AIDS 1997; 11:621-31. [PMID: 9108944 DOI: 10.1097/00002030-199705000-00010] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To compare the progression and non-progression of HIV infection among 418 injecting drug users (IDU) and 422 homosexual men with documented dates of HIV seroconversion from 12 cohorts. METHODS Seroconversion dates were calculated for each subject using a cohort-specific estimate of the cumulative HIV seroincidence over calendar time. In survival analysis, we studied the progression from seroconversion to AIDS and death by risk group. We compared non-progression between both risk groups by evaluating annual CD4 decline over the 7 years following seroconversion among AIDS-free subjects. RESULTS The relative hazard (RH) of AIDS for homosexual men compared with IDU was 1.54 before, and 1.21 after, adjusting for age at seroconversion and year of seroconversion. The risk of death from any cause for homosexual men compared with IDU increased over time since seroconversion. Fifty IDU died prior to AIDS, compared with seven homosexual men (unadjusted RH for homosexual men 0.10). Ignoring this pre-AIDS mortality, the crude RH of death for homosexual men compared with IDU was 2.05. Alter adjusting for age at seroconversion and year of seroconversion in multivariate analysis, the RH became 1.42. No differences in progression between subgroups aged 24 years or older could be demonstrated, but subjects < 24 years were found to be at a decreased risk. Proportions of non-progressors based on CD4 slope > or = 0 at 7 years following seroconversion were higher for IDU than for homosexual men. No differences were found in the proportion (approximately 5%) classified as non-progressors by criteria of both slope > or = 0 and absolute CD4 counts > 500 cells x 10(6)/l, even if pre-AIDS deaths and losses to follow-up were included. CONCLUSIONS We found little evidence for an effect of risk group on progression and non-progression. Pre-AIDS mortality was much higher among IDU than homosexual men. Pre-AIDS mortality and a nonlinear age effect should be considered in planning interventions as well as studies comparing risk groups and modelling the epidemic.
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Affiliation(s)
- M Prins
- Municipal Health Service, Division of Public Health and Environment, Amsterdam, The Netherlands
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