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Two of the most interesting questions often asked about AIDS is why many people do not become immunodeficient or get complicating disease when first infected with Human Immunodeficiency Virus (HIV) and what are the "risk factors" making some individuals more susceptible to the disease. A large majority of people with AIDS have a well established history of drug and alcohol abuse. Both drugs of abuse and alcohol have immunotoxic properties as evidenced by a number of studies. These include marked changes in the cellular, humoral and other components of the immune defense mechanism. Such a compromise of the immune system can render it susceptible to the development of AIDS after HIV infection. This paper reviews the evidence suggesting possible links between substance abuse and its immunotoxicology, and their possible roles in the pathogenesis of AIDS.
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PMID:AIDS, drugs of abuse and the immune system: a complex immunotoxicological network. 174 59

Interviews were conducted with 137 female sex partners of male injection drug users to provide quantitative and qualitative information regarding their AIDS knowledge, attitudes, and specific risk behaviors. Levels of knowledge regarding HIV transmission and prevention were high, with an average of 81.8% correct on a 16-item test. Most women (87.5%) believed that there was at least some chance they would become HIV infected. Substance abuse was prevalent; 67.2% used non-injection drugs (44.5% used crack cocaine), and 32.1% reported prior use of injection drugs. One fifth had engaged in prostitution. Although AIDS knowledge was high, almost all (94.9%) reported engaging in unprotected vaginal intercourse during the previous 6 months, and 6.6% reported anal intercourse without a condom. Among women who did not report consistent condom use, the most frequently stated reasons for non-use of condoms were dislike by their male partner (26.9%) and/or personal dislike of condoms (23.1%). A disturbing pattern of increased risk was observed among black interviewees, who were more likely than Latinas or whites to have contracted syphilis, have multiple sex partners, engage in prostitution, use crack cocaine, and drink alcohol daily.
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PMID:AIDS knowledge, perception of risk, and behaviors among female sex partners of injection drug users. 177 43

Mental health and substance abuse treatment staff completed a set of measures assessing their attitudes, knowledge, and beliefs concerning AIDS. Results indicated that while most staff were aware of basic information about the disease, approximately one-third were not aware of the neuropsychological and psycho-behavioural concomitants of the disorder. Those surveyed were aware of the main transmission routes, but overgeneralized their concern to casual contact. Most staff indicated willingness to work with HIV-infected individuals, although 29% stated they would try to avoid working with them. Interestingly, mental health staff expressed greater hesitancy than substance abuse staff. These and other results are interpreted to suggest that some desensitization of concern may have already occurred among those who have worked with HIV-positive clients. Individuals who had worked with an HIV-positive client had greater knowledge, less discomfort, and were less likely to want to avoid those who are HIV-positive. Questions attempting to identify sources of discomfort in working with AIDS or HIV-positive clients suggested that fear of contagion may be the primary concern, followed by discomfort of working with the terminally ill, and then discomfort with IV drug users and homosexuals. The implications of these results for continuing education activities and staff readiness are discussed.
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PMID:Mental health and substance abuse staff: HIV/AIDS knowledge and attitudes. 185 17

Demographic and clinical data were recorded for 324 patients who visited an AIDS-related psychiatric outpatient clinic over a three-year period. Seventy-five percent of the patients had a diagnosis of AIDS, AIDS-related complex, or asymptomatic HIV seropositivity. Intravenous drug use and heterosexual relations were the most common HIV transmission risk factors. Seventy-three percent of the patients were black or Hispanic; 51 percent were female. In all stages of HIV infection, adjustment disorder was the most common diagnosis; one third to one half of the patients had substance abuse diagnoses. Only 5 percent were diagnosed with dementia, with the incidence highest (12 percent) in patients with AIDS. On the basis of their experience with the clinic, the authors discuss issues that have proved important in the treatment of patients with the triple diagnoses of medical illness, mental illness, and substance abuse.
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PMID:Characteristics of patients attending an HIV-related psychiatric clinic. 186 72

In the United States, the decades preceding the 1980s were characterized by a decline in the incidence of tuberculosis. More recently, the trend has undergone a significant reversal: Case rates have been increasing by 3% to 6% annually. In 1990, more than 25,700 cases were reported to the Centers for Disease Control. In a sense, tuberculosis is adapting to the '90s. The recent increase in its incidence tends to affect populations with identifiable characteristics. Among the most important of these groups are the populations at high risk for infection by the human immunodeficiency virus. The increase is also fueled by cases in populations that are medically underserved, including foreign-born persons from high-prevalence countries, persons with low incomes, and persons living in long-term-care facilities--especially persons with previous tuberculosis infection. Thus, factors such as homelessness, chronic alcohol or drug abuse, malnutrition, and crowded living conditions continue to favor development and transmission of disease. The increase in the incidence of tuberculosis appears to be greatest when subpopulations in such circumstances are also at high risk for HIV infection. Complex issues in the diagnosis and treatment of tuberculosis arise from these epidemiologic patterns. HIV infection is associated with unusual presentations of tuberculosis. Thus, the clinician must maintain a high index of suspicion for the disease in the setting of HIV infection or risk of the infection. The populations at greatest risk are likely to be mistrustful of the medical system, making the long-term administration of potentially toxic chemotherapy more difficult than it already is. Chronic substance abuse may complicate compliance and add further difficulties to the monitoring of chemotherapy. At the same time, the monitoring becomes even more important in the physician's effort to minimize adverse effects of the medications. Outbreaks of drug-resistant disease have recently occurred, complicating the selection of drugs and affecting the duration of treatment. Despite all of these problems, it is essential to establish a diagnosis and initiate treatment rapidly, both to arrest the disease process and to limit its transmission. Since Mycobacterium tuberculosis is spread to uninfected persons in aerosols generated by coughing or sneezing, the infectiousness of a patient with active disease can be related, at least in part, to the number of organisms seen on sputum smears. Initiation of therapy is followed by a rapid decline in infectivity.
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PMID:Tuberculosis: a disease of the 1990s. 191 97

It is projected that the proportion of black Americans, American Indians, Asian Americans, and Hispanic Americans entering the ESRD program will continue to increase. Despite the increase in the average age of the ESRD population, the minorities entering the ESRD program are much younger. The major risk factors of ESRD--hypertension, diabetes, and glomerulonephritis--are affecting these minorities at a higher rate and in varying combinations. High prevalence and severity of hypertension followed by diabetes mellitus are the major risk factors in blacks, especially black women. Heroin and HIV nephropathies, tied to the epidemic of illicit drug abuse, have a major impact on young black men. The high prevalence of diabetes and the epidemic of glomerulonephritis in certain tribes are the major risk factors in American Indians. Hypertension and diabetes are the risk factors for the rapidly increasing Asian American population, especially for the elderly segment of this population. Diabetes predominates as the risk factor for the rapidly growing Hispanic American population, a group that needs to be identified separately within the ESRD program. Diabetes and hypertension are treatable, and adequate control can prevent progression of renal failure. However, with minority groups, it is difficult to fully implement the measures necessary to achieve this control. Outreach programs are necessary not only to provide medical treatment but to include instruction in socioeconomic and educational strategies. Programs that will seek out these patients and treat them should also educate them about their diet, about the detrimental effects of alcohol and smoking, and about the danger of substance abuse. Ultimately, these programs may be much cheaper than supporting a rapidly increasing ESRD program.
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PMID:End stage renal disease in minorities. 192 May 1

The resurgence of tuberculosis in New York City has been largely attributed to the acquired immune deficiency syndrome (AIDS) epidemic. However, historical events predating the advent of AIDS and worsening economic and social conditions, including a rise in homelessness, have contributed significantly to the increase. We prospectively studied 224 consecutive patients with tuberculosis admitted to a large public hospital in New York over the first 9 months of 1988. Initial assessment included medical status, human immunodeficiency virus (HIV) risk factors, and detailed social information, including substance abuse history and housing status. All patients were tracked after discharge to determine compliance and cure rates. Tuberculosis patients were predominantly male (79%), with high rates of alcohol use (53%), intravenous drug and/or "crack" cocaine use (64%), and homelessness or unstable housing (68%). Half the patients had AIDS or AIDS-related complex (ARC) or were HIV antibody positive. A total of 178 patients were discharged on tuberculosis treatment, but 89% of these were lost to follow-up and failed to complete therapy. Of the 178 discharged patients, 48(27%) were readmitted within 12 months with confirmed active tuberculosis. Of these patients, 40 were discharged on treatment and at least 35 were again lost to follow-up. In a multivariate regression model noncompliance was significantly associated with the absence of AIDS or ARC (p less than 0.001), homelessness (p less than 0.005), and alcoholism (p less than 0.05). Because HIV infection and tuberculosis converge in a subpopulation with high rates of substance abuse and homelessness, the problem of ensuring treatment compliance may grow considerably in the future.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Resurgent tuberculosis in New York City. Human immunodeficiency virus, homelessness, and the decline of tuberculosis control programs. 192 42

We characterize associations with and motivations for tattooing in adolescents through data from a controlled, three-group comparison of adolescents from a substance abuse treatment program, detention center, and private pediatric practice. We surveyed 474 adolescents (12 to 18 years old) with tattoos (12%) and without tattoos (88%). The private pediatric practice was the control site. A 34-item questionnaire was used to profile the three groups and their primary associations with tattooing with respect to race, drug use, school attendance, school grades, parental marital status, family income, tattooing by family members, criminal activity, and involvement with satanic rituals. Tattooing was significantly (P less than .005) associated with all of these variables in the ways described, as was knowledge of its association with human immunodeficiency virus infection. No interventions were made. Tattooing is common in adolescents and is associated with low self-esteem, delinquency, drug abuse, family and peer modeling, and participation in satanic rituals. Addressing the behavior as a health problem is discussed.
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PMID:Tattooing behavior in adolescence. A comparison study. 199 84

An American Medical Association committee recently recommended that physicians routinely screen patients for behaviors that put patients at risk for human immunodeficiency virus infection, yet there is evidence that this screening does not occur routinely. Faculty, fellows, and residents at a teaching hospital in a midwestern state with a low prevalence of acquired immunodeficiency syndrome were surveyed regarding their experience in screening for human immunodeficiency virus, their training related to substance abuse and human sexuality, and their confidence and ease in addressing such topics with their patients. Results indicated that only 11% routinely screened patients for high-risk behaviors. While most physicians had received training in human sexuality, most had not received training in substance abuse screening. Those trained felt more confident in addressing substance abuse and human sexuality and felt more comfortable in caring for patients known to be infected with human immunodeficiency virus. A concerted effort to encourage human immunodeficiency virus risk assessment by physicians is needed. This should include training opportunities in screening and counseling patients about sexual activities and substance abuse.
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PMID:Physicians' effectiveness in assessing risk for human immunodeficiency virus infection. 200 Nov 38

A group of patients (N = 1630) hospitalized in Stockholm County with a diagnosis of substance abuse during 1971-1972 were followed through 1984 as regards mortality: 446 (296 males and 150 females) patients died. The excess mortality in the cohort was 5.3 (males 5.8, females 4.6) compared to the general population in Stockholm County. The highest mortality was found in opiate users, with an excess mortality of 18.3. Fifty-one percent of the causes of death belonged to ICD-8 chapter 17, injury and poisoning, and of these, 69% (155 patients) were definite or probable suicides. Since HIV entered the Stockholm drug addict population by the end of this follow-up, the excess mortality reported here can be even higher in the years to come. To follow and monitor the mortality among patients with substance abuse is an important aspect in the evaluation of programs for prevention and treatment.
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PMID:Mortality in patients with substance abuse: a follow-up in Stockholm County, 1973-1984. 206 74


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