Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0019693 (HIV)
 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Heroin abuse is an international problem with which all countries must continually cope. Many countries have implemented heroin substitution therapy as an effective means of decreasing illicit heroin use, crime, HIV risk, and death, and in improving employment and social adjustment. Although methadone is the most commonly used medication for heroin substitution, other agonists in current use include levomethadyl acetate (LAAM), buprenorphine, and pharmaceutical-grade heroin. This report reviews toxicologic issues that arise in these programs. A broad array of testing methodologies are available that allow selection of on-site testing or laboratory-based methodology. Urine specimens may be monitored for nonprescribed drugs on a qualitative or semiquantitative basis. Methods for differentiating opiate sources by urinalysis have been proposed to distinguish poppy seed consumption from heroin abuse and for distinguishing pharmaceutical-grade heroin from illicit heroin. Therapeutic drug monitoring for methadone in plasma continues to be evaluated for use in establishing adequate dosing and detecting diversion, and new methods have been devised for measurement of the optical isomers of methadone in plasma. Biologic specimens, in addition to plasma and urine, have been evaluated for use in drug monitoring, including sweat, hair, and oral fluid, with promising results. Overall, the many recent developments in testing methodology provide more effective means to assess patients in heroin substitution programs and should contribute to improvements in public health.
 ...
PMID:Toxicologic aspects of heroin substitution treatment. 1189 65

A sero-surveillance program in the state of Manipur, India revealed an alarmingly high rate of HIV infection, detected primarily among intravenous drug users. Previous surveillance had indicated that heterosexual intercourse was the leading mode of HIV transmission, and in 1989, no HIV infections had been detected in Manipur. But in February 1990, 5 HIV-positive cases were reported, and by May 1991, 1263 had been reported -- 93.9% of them among intravenous drug users. This came as shocking news, considering that at the same time only 5131 HIV cases had been reported in all of India. Although Manipur makes up only 0.91% of the country's population, the state's intravenous drug account for 23.1% of the nation's HIV cases. Manipur has an estimated 30,000 drug addicts, approximately 1/2 of which are intravenous drug users. Heroin is easily available in Manipur, due to the fact that the state shares a common international border of 352 km with Myanmar, one of the 3 countries that make up Southeast Asia's heroin producing "Golden Triangle." The author stresses, however, that drug abuse is not the cause of the transmission of HIV. It is the sharing of needles and syringes among intravenous drug users that creates the risk of infection, and preventive measures should reflect that fact. Besides discouraging drug use, preventive measures will require a dual strategy: 1) until they are cured, intravenous drug users should be given sterilized needles and syringes to avoid sharing; and 2) the law needs to be revised so that drug addicts are treated as patients and not as criminals. The Voluntary Health Association of India has begun to discuss such measures with governmental and nongovernmental organizations involved in the prevention and control of AIDS.
 ...
PMID:Shocking findings in Manipur. 1228 27

Improved family and community support would prevent many youth in Nigeria from risk behavior including drinking alcohol, smoking, and using illicit drugs. In Rivers State, 70% of secondary students have had at least 1 alcoholic drink. Further, in Bendel State, 13% of 15-19 year olds in the coastal region drink alcohol compared with 75% of those in the hinterland. Since alcohol affects good judgment skills, this behavior is especially risky during rituals and social activities and causes accidents. Youth who drink are likely to have unplanned and unprotected sexual intercourse. Drinking during pregnancy is associated with miscarriages, low birth weight, and birth defects. Despite the problems with youth and drinking, Nigeria does not have law restricting sales of alcohol to youth. In Nigeria smoking was once predominantly a male habit but is now increasing quickly among women. Most smokers 1st begin their habit when 18 years old. Even thought he Nigerian government has restricted smoking in public places, it has not yet been effective. Smoking has numerous negative effects such as lung cancer, other cancers, shorter life spans, low birth weight, prematurity, higher perinatal mortality, and more labor complications. Moreover the tobacco and alcohol companies advertise widely using ingenious and persuasive promotions. Youth are especially vulnerable to these slick promotions. Cannabis remains the most common illegal drug. Heroin use is growing among urban adolescents in Nigeria, however. Nigeria also serves as a transhipment point for drugs to the US as well as a consumption point. Drug use results in rising numbers of patients in mental hospitals and treatment centers. A particular concern of drug use is transmission of HIV and hepatitis B via needles. Smokers and alcohol drinkers are likely to also be drug users. Families, government, and community organizations need to collaborate to prevent these risk behaviors among youth.
 ...
PMID:Nigeria's youth at risk. 1231 98

In December 2002, the author conducted a comprehensive review of indicators of use of illicit substances in the San Francisco Bay Area. Cocaine use prevalence appears to be rising again, after a significant decline in the late 1990s. The shift away from smoking crack and toward snorting powder cocaine persists. The former predominance of Blacks among users continues to ebb. Heroin use indicators consistently show a peak in 1999, followed by a significant decline. The average age of users keeps increasing. Local street prices of heroin have risen considerably since 2001. Marijuana indicators suggest a continued increase in prevalence. Methamphetamine indicators are mixed. Usage is still widespread, and risky injection practices among gay/bisexual men remain a major factor for HIV incidence. Incidence of new HIV infection declined between 1997 and 2001 for heterosexual drug injectors, but increased for gay male and transsexual injectors.
 ...
PMID:Patterns and trends of drug use in the San Francisco Bay Area. 1282 55

Identifying which mental disorders, substance use, and regimen factors influence non-adherence is a critical step in developing patient-customized interventions. In this cross-sectional study, 120 adults with HIV taking antiviral therapy completed interviews and questionnaires on their medication regimen, adherence behaviours, mental distress, and substance use patterns. They provided access to medical records for measures of immune health. Demographic characteristics, regimen factors, mental health indicators, and substance use variables were evaluated as predictors of four dichotomous non-adherent behaviours: running out of medications, not always taking medications as directed, taking below 95% of protease inhibitor doses, or having notations of non-compliance in the medical record. Non-adherence was prevalent and was related to immune health. Recent crack cocaine use was a risk factor for both taking a low proportion of PI medication and charted non-compliance notations. Heroin use and screening positive for social phobia were risk factors for running out of medication. Screening positive for any anxiety disorder reduced the risk of failing to take medications as directed. Clinicians caring for patients with HIV should screen for non-adherence using multiple behavioural indicators, and assess and treat substance use and anxiety disorders to reduce the risk of non-adherence.
 ...
PMID:The impact of psychiatric symptoms, drug use, and medication regimen on non-adherence to HIV treatment. 1467 26

Heroin use, particularly injection use, is a problem of great public health importance. The risks associated with heroin dependence, such as HIV and viral hepatitis, and the social costs due to associated crime and poverty exceed those of most other drugs of abuse. Increasing purity and decreasing cost of heroin likely contribute to trends of decreasing age at first use and an increasing rate of initiation into regular use in the United States. Effective treatment is available for heroin dependence, so primary care providers should screen patients for this disorder. This article reviews the epidemiology of heroin use and dependence in the United States and outlines what is known regarding risk factors for initiation of heroin use and for heroin dependence.
 ...
PMID:Heroin dependence. 1548 66

Mexico has cultivated opium poppy since before the 1900's and has been an important transit route for South American cocaine for decades. However, only recently has drug use, particularly injection drug use, been documented as an important problem. Heroin is the most common drug used by Mexican injection drug users (IDUs). Increased cultivation of opium poppy in some Mexican states, lower prices for black tar heroin and increased security at U.S.-Mexican border crossings may be contributing factors to heroin use, especially in border cities. Risky practices among IDUs, including needle sharing and shooting gallery attendance are common, whereas perceived risk for acquiring blood borne infections is low. Although reported AIDS cases attributed to IDU in Mexico have been low, data from sentinel populations, such as pregnant women in the Mexican-U.S. border city of Tijuana, suggest an increase in HIV prevalence associated with drug use. Given widespread risk behaviors and rising numbers of blood borne infections among IDUs in Mexican-U.S. border cities, there is an urgent need for increased disease surveillance and culturally appropriate interventions to prevent potential epidemics of blood borne infections. We review available literature on the history of opium production in Mexico, recent trends in drug use and its implications, and the Mexican response, with special emphasis on the border cities of Ciudad Juarez and Tijuana.
 ...
PMID:Historical trends in the production and consumption of illicit drugs in Mexico: implications for the prevention of blood borne infections. 1610 72

This paper on drug use and HIV/AIDS in China follows on from the column's May 2005 article on the description of the first methadone maintenance clinic in Beijing. Methadone maintenance clinics and needle exchange programmes are now being implemented in China as a response to the rapid increase in prevalence of HIV/AIDS over the last 10-15 years. It is worth noting that in prior years methadone was available only as for short-term detoxification from opioids and for research purposes. Accordingly, the Department of Health Education and Behavioural Intervention at the National Center for AIDS Prevention and Control in China plans to establish 1,000 methadone replacement clinics within the next 5 years to treat 200,000 heroin-dependent users who are at increased risk of HIV/AIDS. Robert Ali & Rachel HumeniukEditors, Asia Pacific ColumnThe cumulative number of registered drug users in mainland China increased from 70,000 in 1990 to 1.14 million in 2004. Heroin continues to be the most commonly used drug in China; however, polydrug use is popular among heroin users. Sedatives/hypnotics (e.g. triazolam) and other uncontrolled prescription opioids (e.g. pethidine and tramadol) are used commonly in combination with heroin. The majority of drug users (79%) are young people aged between 17 and 35 years and comprise predominantly farmers (30%) and unemployed people (45%). The HIV/AIDS epidemic in China has reached expansion phase (1995-present). It is estimated that the actual number of HIV/AIDS cases reached 840,000, including 80,000 actual AIDS patients, in 2003, with injecting drug users (IDUs) making up the largest proportion of these cases. Although the prevalence rate of HIV/AIDS is only 0.065% in the Chinese population overall, there is potential for an explosive spread of HIV/AIDS if preventative measures are not employed. Supported by the Chinese government and other related international organisations, harm reduction strategies such as methadone maintenance treatment (MMT) and needle-syringe programmes (NSP) have commenced implementation to reduce the risk of HIV infection among heroin users.
 ...
PMID:Drug use and HIV/AIDS in China. 1662 8

HIV-infected substance users have poorer health outcomes than other HIV risk groups. Few studies have examined the impact of specific types of substance use on health care. This study investigated the associations between specific types of substances of abuse and access to health care. HIV-infected individuals living in eight different single room occupancy hotels in the Bronx, New York, were interviewed between August 1999 and February 2001 regarding demographics, health care access and utilization, and drug and alcohol use. Of the 238 participants, the majority were male (59%), black or Hispanic (93%), and active drug users (61%). Individuals reporting any drug or crack/cocaine use were less likely to have a regular provider than those reporting no drug or no crack/cocaine use (adjusted odds ratio [AOR] = 0.50, p = 0.05; AOR =0.35, p = 0.004, respectively), while those with binge alcohol use were more likely to have a regular doctor than those without binge alcohol use (AOR = 2.61, p = 0.05). Individuals reporting any drug or crack/cocaine use were also less likely to perceive quality of health care positively (AOR = 0.50, p = 0.02; AOR = 0.37, p = 0.002, respectively). Heroin use, and injection drug use were not associated with these outcomes. When the sample was limited to recent drug users, similar patterns were found. Although drug use in general is associated with negative health outcomes, in this study, poorer measures of access to health care among substance users was associated predominantly with crack/cocaine use. It is important that clinicians and researchers working with substance-using populations understand how specific types of substance use differentially impact on health care.
 ...
PMID:Type of substance use and access to HIV-related health care. 1678 53

This article reports on a rapid assessment (RA) carried out in the city port of Mombasa, Kenya in March 2004 by the Omari Project to inform the scaling up of their services to heroin users. Heroin has been a street drug in Mombasa for over 25 years. From 1998, white crest, probably from Thailand, started to replace brown sugar, and there was a major shift from inhalation of the vapor ("chasing the dragon") to injecting. The Omari Project has been monitoring the heroin situation in Mombasa and treating heroin users from Mombasa since 1997. In the course of the RA, 496 heroin users were interviewed of whom 95% were men and 5% were women. A range of methods were used, including mapping of the Mombasa region, work with a key informant/guide who was a heroin user, administration of a brief questionnaire and informal interviews, and feedback of findings to other local agencies working with drug users. Respondents were from a wide range of cultural/ethnic groups, the two largest being Mijikenda and Swahili, who are indigenous to the Kenya coast. Overall, 15% of respondents had "ever injected" heroin, and 7% were current injectors (n = 37). These data indicate a shift away from injecting but also reflect the death of many established injectors, either through overdose or AIDS or hepatitis. The figure of 7% of the sample reporting being current injectors is likely to be an underestimate. Syringes were available from a number of pharmacies and most injectors reported using a syringe for 1-3 days. The majority reported injecting in a group of three or more and described risk behaviors for HIV transmission. The results of the assessment highlight the need for a range of services, including needle exchange, counseling, and referral to residential treatment programs. However, progress toward responding to the findings of the RA by establishing effective services are hampered because of legal impediments to operating needle exchange programs in Kenya.
 ...
PMID:A rapid assessment of heroin use in Mombasa, Kenya. 1680 85


<< Previous 1 2 3 4 5 6 Next >>