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Query: UMLS:C0019693 (HIV)
 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Pituitary gland volume was measured in 16 men between the ages of 26-33 with magnetic resonance imaging. Eight male patients had a Diagnostic and Statistical Manual III-Revised, American Psychiatric Association Axis I diagnosis of concurrent opioid and cocaine dependence. The average duration of opioid and cocaine abuse was 7.8 +/- 2.0 and 6.9 +/- 1.4 yr, respectively. All patients were in good physical health as determined by physical examination, blood chemistry, hemogram and hormone analysis, and all tested negatively for the HIV antibody. No patient had any other Diagnostic and Statistical Manual III-Revised Axis I diagnosis or neurological disorder. Eight healthy males served as age-matched control subjects. None of the control subjects had any past or current history of substance abuse or any clinical indication for magnetic resonance imaging. Opioid and cocaine dependent men had significantly larger pituitary gland volumes (730.0 +/- 24.4 mm3) than control subjects (540.0 +/- 26.6 mm3) (P < 0.01). The significant increase in pituitary gland volume in men who abuse opiates and cocaine may be antecedent to detection of abnormal anterior pituitary hormone function.
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PMID:Pituitary volume in men with concurrent heroin and cocaine dependence. 850 Nov 61

The authors implemented a three-day faculty development program on substance abuse and AIDS for primary care faculty. Objectives included: 1) increased knowledge concerning clinical issues; 2) skill development focusing on provider-patient interactions; and 3) the development of educational approaches for teaching about substance abuse and AIDS. Teaching formats included didactic (40%) and experimental (60%) sessions emphasizing role playing with patients affected by both substance abuse and HIV infection. Four courses have been given to 109 participants, who have rated the course highly in terms of its educational quality (4.4/5.0) and usefulness (4.2/5.0). At six-month follow-up, 75% of the participants reported enhanced teaching as a result of this faculty development program.
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PMID:Substance abuse and AIDS: a faculty development program for primary care providers. 850 87

This paper reviewed heroin use data from the US government's epidemiologic monitoring system for substance abuse. The monitoring system has multiple components, i.e., the Drug Abuse Warning Network of reporting emergency rooms (9), annual surveys of high school and post-high school youth (3, 4), annual National Household Surveys of Substance Abuse (7, 8, 50), Drug Use Forecasting (51), the Community Epidemiology Work Group (52), and law enforcement systems not reviewed here. These monitoring systems should identify any major increase in heroin incidence in this country relatively early. This is important, because the early stages of heroin epidemics are often hidden from society, and the epidemics are already full-blown by the time health and other agencies become aware of the size of the affected population and are required to respond. The hidden or underground nature of heroin epidemics is caused by 1) the need of each user to hide an illegal activity and 2) the delay between the time when heroin is first used and the onset of physical dependence and other adverse consequences, which bring new heroin addicts to the attention of treatment and enforcement systems. Despite an epidemiologic surveillance system which should rapidly identify large-scale heroin spread in this country, our treatment and law enforcement systems are not organized to respond rapidly to contain an epidemic. Substance abuse treatment services are not structured for rapid expansion and contraction based on fluctuating need. Apart from HIV prevention programs, we do not have outreach teams attached to treatment programs that could quickly identify local outbreaks and involve new heroin abusers in treatment (10).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Heroin epidemics revisited. 852 47

Since 1990 216 HIV-infected pregnant women have been enrolled in an ongoing nationwide study named "HIV and Pregnancy" financed by the Swiss Federal Office of Health (No. 90-7007 and 93-7131). Of a total of 228 recorded pregnancies 154 continued to parturition. Until now it has been definitively established whether or not 89 offsprings have been infected with HIV by their mothers. According to clinical and immunological findings most of the pregnant women are still in early, stable stages of HIV-infection (stages II and III of the CDC classification system in 94% of the subjects; mean CD4-cell count around 600/microliters). HIV infection was the consequence of an intravenous substance abuse in two thirds of the women. Detailed interviews revealed an alarming negligence with regard to compliance with safer sex recommendations and contraception. Advisory services of specialized AIDS information centers have very rarely been called on. In our group, the vertical transmission rate shows a statistically significant correlation with low maternal anti-HIV-p24 antibody titers, high serum neopterin- and IgA-concentrations, and also with the use of forceps and vacuum in vaginal delivery. Maternal substance abuse but not HIV infection itself resulted in an incidence of preterm deliveries roughly twice as high as in the normal Swiss population.
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PMID:[HIV and pregnancy]. 853 80

In the wake of the HIV/AIDS and crack cocaine epidemics, poor urban communities face growing numbers of older adults, largely grandmothers, who have become surrogate parents to children orphaned by these epidemics. This study is the first in the United States to determine the prevalence of older surrogate parents among families registered at pediatric clinics. The three clinics selected were in low income neighborhoods of New York City with a high incidence of female HIV/AIDS and substance abuse. Using a 50% random sample of 1,375 records of registered families, data were obtained on the number and ages of relatives serving as surrogate parents. In 11% of these 1,375 families with children 12 years and under a parent was not the caregiver. In 8% the caregiver was a grandmother. Forty-seven percent of these women were 55 years or older, 25% were 60 years or older and 8% were 70 years or older. Most of these women were caring for more than one child. Ten percent of the total of 2,445 children, 12 years and under, lived in non-parent headed families. Eight percent lived with a grandmother, 1% with other parental generation relatives and 1% in foster care. Given the stresses associated with caregiving in late life and the greater risk of poor health among low income African-American and Hispanic elderly, older surrogate parents from these communities are a potentially high health risk population whose own needs may go unrecognized and unattended. The young ages of the children suggest that many grandparents may continue to be caregivers as they reach their sixties, seventies and even eighties. Clinical and longitudinal data are needed to determine how prolonged surrogate parenting in late life affects the health of older caregivers and the children in their care. Coordination between health and social services for the elderly and for children are needed to promote effective programs for these families.
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PMID:The prevalence of grandmothers as primary caregivers in a poor pediatric population. 855 Aug 67

This article describes the development and implementation of the AIDS home care program at the Visiting Nurse Service of New York (VNSNY). The challenges to VNSNY staff are diverse and include (1) dealing with staff who are infected or affected by HIV in their own families; (2) working with other community-based case managers; (3) working in high crime areas and dealing with substance abuse; (4) managing families in crisis; (5) dealing with violence and abuse in the home, including staff abuse; (6) managing problems with informal caregivers; (7) managing clients who participate in unsafe sexual activities; and (8) dealing with issues of HIV confidentiality.
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PMID:Challenges for the urban home health care provider. The New York City experience. 860 88

An exploratory study was conducted with 27 injecting drug users (IDUs) on psychosocial factors (stress, coping reactions, and attitudes toward HIV illness and treatment) which are relevant to treatment acceptance and adherence. A semi-structured interview was used to collect qualitative data in a sample of 13 seropositive and 14 seronegative subjects. The results indicated a range of HIV-specific stressors such as social stigma, uncertainty about the future, disclosure of seropositive status, and monitoring of HIV illness. Seeking of social support, relapse to substance abuse, and mental disengagement were the most common coping reactions reported by the sample; there was a lack of behavioral, problem-focused responses. The study also provided descriptive information on attitudes toward HIV treatment, including fatalism, optimism (hope and control), and ambivalence regarding treatment efficacy. Clinical implications and suggestions for future research are discussed.
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PMID:Stress, coping, and attitudes toward HIV treatment in injecting drug users: a qualitative study. 867 95

As the 21st century approaches and the proportion of the US population over 65 years of age increases, it is expected that the demand for long-term care will expand dramatically. This expectation has been widely discussed. Less widely discussed is a potential for increase in the demand for long-term care resulting, not from the geriatric conditions with which the industry is already familiar, but from chronic and debilitating substance abuse-related diseases. In the United States, the incidence of severe cardiovascular and hepatological deterioration in younger patients has begun to increase, partly due to the increased scope of drug use and the increased variety of drugs used by individuals under the age of 35. HIV disease progression resembles these degenerative conditions in some important ways, and HIV infection is now often accompanied by substance abuse disorders. Thus, the care of HIV-infected patients can serve as a model for the impact on the long-term care industry that this new type of patient is likely to make. Using HIV as a particularly dramatic example, this paper discuss those changes in detail, and concludes with recommendations for successfully adapting to them.
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PMID:Drug abuse, AIDS, and the coming crisis in long-term care. 870 75

Incomplete antituberculous chemoprophylaxis and treatment are major causes of the resurgence of tuberculosis, often drug-resistant, among drug users. We offered directly observed antituberculous chemoprophylaxis (n = 102) or treatment (n = 12) to tuberculous chemoprophylaxis (n = 102) or treatment (n = 12) to eligible methadone maintenance treatment patients. Methadone dosing was not contingent upon ingestion of antituberculous medication(s). No material incentives were provided. Ninety (88%) prophylaxis and 9 (75%) treatment patients were administered > or = 5 weekly doses of antituberculous medications during > or = 80% of 4740 patient-weeks. The majority of patients were HIV-seropositive. Active substance abuse was not associated with diminished adherence. Over 80% of patients completed or were still receiving therapy at the end of the study. Adherence to and completion of directly observed antituberculous therapy can thus be attained by drug users in treatment, despite ongoing drug misuse. Substance abuse treatment programs provide opportunities for enhanced compliance, and should thus be viewed as critical components of strategies to address the tuberculosis epidemic in drug users.
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PMID:Successful adherence to observed prophylaxis and treatment of tuberculosis among drug users in a methadone program. 872 49

Sexual risk for HIV transmission under the influence of alcohol and/or other drugs is not simply a cause-effect relationship: not everyone who drinks or uses other drugs has unprotected sex. The purpose of this study is to explore differences between substance using gay/bisexual men who use condoms during anal sex from those who do not. These differences are identified by comparing men whose anal sex while under the influence of alcohol and/or drugs is consistently protected to men whose anal sex while under the influence of alcohol and/or drugs is consistently unprotected. Gay/bisexual men entering substance abuse treatment at a gay-identified agency in San Francisco were recruited to complete surveys and to be interviewed about sexual behavior, substance use, and related variables using an extended version of the Timeline Follow-back (TL). The TL procedure uses a blank calendar form and a series of questions to cue recall of drinking, drug use, and anal intercourse on each of the 30 days prior to the last date of alcohol and/or drug use. Men whose anal sex while under the influence of alcohol and/or drugs is consistently unprotected were significantly more likely to report having less than a college education (p = .04), more likely to have an income of less than $20,000 (p = .01), more likely to use amyl nitrite (p = .01) and cocaine (p = .02), and more likely to report a higher frequency of anal sex (p = .007). In addition, they were less likely to approve of sex without love (p = .003), less likely to perceive that safer sex is the community norm (p < .001), and less likely to have encouragement from friends to practice safer sex (p = .001). However, HIV status did not differentiate between the two groups. These two groups provide clear and interesting contrasts in terms of behavior, thus comparisons of the factors influencing sexual safety in these subgroups may enhance our understanding of risk taking. A better understanding of possible mediating variables can be important both in guiding future research in this area and in formulating intervention strategies to target gay men who drink or use drugs in combination with sexual activity.
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PMID:Condom use among gay/bisexual male substance abusers using the timeline follow-back method. 873 May 28


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