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 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To slow the spread of AIDS, it may be important for substance abuse treatment programs to give priority admission to patients who are HIV-infected and infectious. A new program is described that provides methadone maintenance treatment to opiate addicts who are "AIDS affected"--heroin addicts diagnosed with AIDS, AIDS-related complex (ARC), or other significant symptoms of HIV infection. The program aims to protect the health of patients and to protect the general public by slowing the spread of the human immunodeficiency virus (HIV). This article describes the program's history and goals, its referral and patient admission process, methods of assessment and treatment planning, medical care, counseling procedures, tolerance for misbehavior, philosophy toward eventual detoxification, and procedures that maintain confidentiality.
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PMID:Methadone maintenance program for AIDS-affected opiate addicts. 274 16

This study examined the pattern of neuropsychologic abnormalities in three groups of subjects: 20 patients diagnosed with Acquired Immunodeficiency Syndrome (AIDS); 14 patients diagnosed with AIDS Related Complex (ARC); and 13 seronegative controls. Subjects with past history of chronic substance abuse, neurologic disease, or focal findings on MRI or CT were excluded. All subjects were administered a comprehensive neuropsychological battery. Results revealed a pattern of preserved attention and concentration, language skills, and most visuospatial construction abilities in the presence of more notable deficits in nonverbal memory and speeded psychomotor tasks. Practical implications for the early detection of HIV-1 related cognitive dysfunction are addressed.
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PMID:Neuropsychological performance in HIV-1 immunocompromised patients: a preliminary report. 280 63

Accurate description of the prevalence of neurological impairment in healthy individuals who are infected with human immunodeficiency virus type 1 (HIV-1) has relevance for public health policy, for employment issues, and for planning future health needs. Within the Multicenter AIDS Cohort Study, we determined the cross-sectional prevalence of neurological abnormalities in 270 HIV-1 seropositive homosexual and bisexual men in Centers for Disease Control Groups II and III, using a control group of 193 HIV-1 seronegative homosexual men. Utilizing a neurological and neuropsychological screening battery, we found no differences in the prevalence of neuropsychiatric symptoms or in neuropsychological performance. One hundred nineteen subjects with abnormalities on screening tests completed additional neuropsychological testing and had neurological examinations. The majority had normal results and the frequency of neurological abnormalities and impaired neuropsychological performance was not significantly increased among HIV-1 seropositive subjects. Most of the abnormalities could be attributed to causes other than HIV-1. One subject had mild HIV-1-related dementia, yielding a prevalence of 3.7:1,000 (95% confidence interval: 0.19-23.7:1,000). Magnetic resonance imaging demonstrated sulcal prominence and focal areas of high signal intensity in white matter in 63% of HIV-1 seropositive subjects and 48% of uninfected control subjects. Abnormalities in cerebrospinal fluid were noted in 23 (85%) of 27 HIV-1-infected individuals. Our studies indicate that the prevalence of dementia and other HIV-1-related neurological disorders is very low among healthy HIV-1 seropositive homosexual men. The confounding effects of factors such as substance abuse or preexisting medical conditions must be considered in the neurological evaluation of such patients.
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PMID:Low prevalence of neurological and neuropsychological abnormalities in otherwise healthy HIV-1-infected individuals: results from the multicenter AIDS Cohort Study. 281 36

With the increasing incidence of substance abuse in the United States, there has been a concomitant increase in the number of women becoming pregnant while using substances of abuse. The infant delivered to a drug-addicted woman is at risk for problems of growth and development as well as neonatal abstinence, and is also at increased risk of infections and exposure to HIV. The long-term outcome of these infants is influenced not only by the mother's use of illicit substances but by the frequent additional use of licit substances, such as cigarettes and alcohol. The drug-seeking environment in which many of these children are raised also may impair maximal development for these infants. In addition, many women from substance-abusing backgrounds lack a proper model for parenting and require intervention by the health care community to guide them in their roles as parents. Thus, multiple factors in the lives of these children, compounded by the early neurobehavioral deficits of drug-exposed newborns, earmark these infants to be at high risk for continuing developmental and later school problems.
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PMID:Drug use in pregnancy: parameters of risk. 305 6

The dual diagnosis of AIDS and substance abuse raises serious clinical and ethical issues for health care providers. Often, there are barriers to the diagnosis and referral for substance abuse treatment in people with HIV infection. Countertransference is one such barrier. Important educational needs of patients can be overlooked or not fully addressed. Essential information needs to be conveyed, regardless of whether or not a patient seeks substance abuse treatment. Early intervention and treatment are essential to minimize risk for HIV infection and transmission to others. Specific clinical issues that practitioners often address for patients with AIDS or ARC are appropriate interventions for denial of the HIV-related diagnosis coupled with the denial of substance abuse, difficulties in pain management, the difficulties of family and loved ones, the need for substance abuse relapse prevention, and the need for coordination of care among agencies.
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PMID:Treatment of substance abuse in patients with HIV infection. 348 40

Careful interviewing of alcoholics who wish to undergo alcohol withdrawal programmes reveals that some are past intravenous drug abusers. As these two potentially hepatotoxic types of substance abuse could cause liver disease or influence its clinical course, we studied biological, histological and virological features in 26 alcoholics with a past history of intravenous (i.v.) drug abuse, compared with paired controls (alcoholics without i.v. drug abuse). There were no differences with regard to routine liver test results. In contrast, the former drug abusers had a significantly higher prevalence of serum markers of hepatitis C (76.9%) and hepatitis B viruses (76.9%) than the other patients (16.7 and 12.5%, respectively). Eight patients, all of whom were HBs Ag negative, were positive for serum HBV-DNA; three were former drug abusers and five were not, giving an overall prevalence of HBV markers in the two groups of 80.8 and 25%, respectively. Two former drug abusers had anti-HIV antibodies and one had anti-hepatitis delta virus antibodies. Ten of the 17 former drug abusers who underwent liver biopsy had histological signs of viral infection. These data underline the need for careful interviews of alcoholic patients, together with serological tests for viral infections and histological analysis of the liver, as some will have liver-damaging viral diseases and may be candidates for anti-viral (i.e. interferon) treatment.
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PMID:Clinical impact of drug addiction in alcoholics. 753 99

The Youth AIDS Prevention Project (YAPP) program was designed to prevent STDs, HIV/AIDS, and substance abuse among junior high school students. The 15 participating school districts at high risk of HIV infection were recruited in the Chicago metropolitan area. The program began during the 1991-1992 school year (7th grade portion of the program) and continued through the 1992-1993 school year (8th grade portion of the program). During the year of intervention control students received basic AIDS education. The number of students with matching posttest data decreased to 1669 (1001 treatment and 668 control) by the end of 8th grade. Students in the treatment condition were significantly more likely to report ever using condoms with foam (24.3% of 186 treatment students vs. 14.5% of 124 controls, p 0.01). Among students who were sexually active the past month, treatment students were more likely to have engaged in protective behaviors during that time than control students (87.8% of 49 treatment students used condoms vs. 76.7% of 43 controls; and 40.8% used condoms with foam vs. 25.6% of controls). More than 97% of students in both treatment and control groups stated they intended to use a condom if they planned on having sex in the next 12 months. In contrast, treatment and control groups differed significantly with respect to their intentions to use condoms with foam in the next 12 months (84.6% of 186 treatment students vs. 62.9% of 124 controls, p 0.001). Multivariate logistic regression analyses predicted protective behaviors for changers in the past 12 months (n = 312) and for changers who were sexually active in the past 30 days (n = 92). Gender and race were significant predictors of condom with foam use in the past year, with males and Hispanics significantly more likely to report use of condoms with foam (p 0.05). For changers who were sexually active in the past month, YAPP students were marginally more likely than controls, and males were almost 3.5 times as likely as females to report using condoms with foam.
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PMID:Impact of a school-based AIDS prevention program on risk and protective behavior for newly sexually active students. 760 52

When challenged by complex medical and social conditions, local providers must participate in information exchanges, resource sharing, continuing education, and service coordination. A community exchange system, flexible enough to share and adapt new knowledge, and able to provide continuing multidisciplinary training and education across different practice settings, was established for the prevention and treatment of HIV/AIDS in East Harlem, New York City. The HIV/AIDS community exchange system supports linkages among disciplines within a medical center, communication among the local community-based organizations, and networks between the two settings. The system, as a model, is applicable to complex socio-medical problems such as diabetes, substance abuse, violence, tuberculosis, or geriatrics.
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PMID:Linking frontline work and state-of-the-art knowledge: a community exchange system. 762 98

To describe characteristics of persons with late (at or after death) acquired immunodeficiency syndrome (AIDS) diagnosis, we analyzed national surveillance data among all persons with AIDS diagnosed through December 1991 under the pre-1993 AIDS case definition and with a known date of death. Late diagnosis was present in 15.8% of 163,202 decreased persons with AIDS and in 15.3% of decreased men with AIDS, 20.6% of women, 12.1% of whites, 20.0% of blacks, 21.1% of Hispanics, 12.3% of men who have sex with men (MSM), 21.9% of injecting drug users (IDU), and 19.6% of persons exposed to human immunodeficiency virus (HIV) through heterosexual contact. When age, race/ethnicity, sex, geographic region, and transmission mode were included in logistic regression analyses, among adults/adolescents, late diagnosis was more likely among persons 40 years or older than among those 13-39 years old, among blacks and Hispanics than among whites, and among IDU and persons exposed to HIV through heterosexual contact than among MSM. Although children (less than 13 years of age) were more likely to have late diagnosis than adults and adolescents, late diagnoses among children did not differ significantly by race/ethnicity, sex, geographic region, or transmission mode. Late AIDS diagnosis, especially among ethnic minorities and IDU and their sex partners, may represent delays in HIV diagnosis and care. In addition to not receiving early clinical intervention, persons who are diagnosed later in the course of HIV disease represent missed opportunities for receiving prevention efforts such as education, counseling, and substance abuse treatment.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Characteristics of persons with late AIDS diagnosis in the United States. 763 46

Available data (this review includes old major articles and recent articles) show that, although results are heterogeneous, methadone maintenance treatments (MMTs) have a real efficiency not only to reduce illicit opiate abuse (50-80% of patients under MMT did not use heroin in the preceding month) but also to reduce criminality, HIV risks and mortality, and to improve social rehabilitation, without inducing other alternative substance abuse. A minority of patients (perhaps 5-20%) stay on MMT on a very long-term basis (more than 10 years). Efficiency of MMTs are rather poorly related to patients' variables, with the exception of a moderately deleterious effect of a low age at onset of opiate dependence, a precocious or high involvement in criminality and an abuse of non-opiate drugs. On the other hand, variables related to treatment play a more important role in explaining heterogeneity of results. Optimal daily dose, high quality of medical and psycho-social services, clear orientation towards social rehabilitation and treatment retention (to allow a sufficient duration of treatment) and slow detoxification regimen of well-stabilized patients are all factors contributing to better results.
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PMID:Methadone maintenance treatment: an update. 765 87


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