Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0021051 (immunodeficiency)
 71,517 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Infection with the human immunodeficiency virus (HIV) is a significant and growing problem among intravenous drug users (IVDUs), both from the standpoint of personal morbidity and public health concerns regarding spread of the virus. Most HIV-infected IVDUs are opioid addicts. The most common form of long-term treatment of opioid dependence is methadone maintenance treatment (MMT). MMT can therefore play an important role in both AIDS prevention and reduction of HIV-related morbidity through diminishing drug use, promoting a healthier life-style, and providing direct medical and psychiatric care. Attempts to manage patients with a triple diagnosis of drug abuse, medical, and psychiatric problems can pose significant clinical challenges, requiring the efforts of a multidisciplinary team. The management of HIV-infected patients in MMT is discussed and case examples from the MMT program of the San Francisco General Hospital Substance Abuse Services are presented to illustrate useful strategies in the care of these complicated patients.
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PMID:HIV-infected intravenous drug users in methadone maintenance treatment: clinical problems and their management. 166 16

4000 sera were tested for antibodies against hepatitis C virus (HCV) by means of an ELISA using the C100-3 antigen. 38.9% of patients with non-A, non-B hepatitis following blood transfusion (n = 108) had HCV antibodies. Among patients with chronic liver damage of unknown origin (n = 316) 30.4% were anti-HCV positive, and in 2,506 patients with transitional or chronic elevation of transaminases 14.8% showed HCV antibodies. Haemophiliacs (n = 26) with 65.4% anti-HCV positives and drug addicts (n = 46) with 56.5% anti-HCV positives had the highest prevalence among high risk groups. Addicts dying from drug abuse (n = 216) and HIV 1 positives (n = 127) were anti-HCV positive in 37.5% and 26.0%, respectively. Patients on haemodialysis (n = 331) had antibodies against HCV in 12.4%. Health care workers (n = 217) appear to be at a comparably low risk with only 2.8% anti-HCV positives. Up to now we could not find a single case of intrafamilial spread of HCV in 46 examined cases. We suggest that HCV infectivity of contaminated body fluids and blood is lower than that of hepatitis B virus or human immunodeficiency virus type 1 carriers. In suspected non-A, non-B hepatitis negative test results should be confirmed in a second sample because it may take three to six months after infection before HCV antibodies occur. However, about 10% of chronic HCV infections are not detectable with the presently available test. This may change when new tests become available using HCV specific antigens other than C100-3.
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PMID:Hepatitis C virus antibodies among different groups at risk and patients with suspected non-A, non-B hepatitis. 171 Oct 18

Human immunodeficiency virus (HIV)-associated myocarditis is well reported. Many of these patients are also intravenous (IV) drug abusers. This study examined sudden death victims from the Office of the Chief Medical Examiner, State of Maryland, for active myocarditis. A group of HIV-negative drug abusers is compared with a group of HIV-negative victims without any known risk factors for the acquired immunodeficiency syndrome. Using modified Dallas criteria combined with an avidin-biotin-labeled immunoperoxidase procedure, the cases were classified as active, borderline, or absent myocarditis. Serologic analysis for circulating antimyocardial antibody was performed along with phenotypic analysis of the infiltrate. Of the 15 IV drug abuse cases examined, none were positive for HIV (enzyme-linked immunosorbent assay and Western blot). With IV drug abuse as the primary risk factor, five cases demonstrated active myocarditis, while five others had borderline myocarditis. Only one of 10 low-risk patients had a lymphocytic infiltrate consistent with borderline myocarditis. Drug abuse-related myocarditis was associated with cardiac pathology resulting in sudden death in only one case. Antimyocardial antibodies were positive in four of the 15 IV drug abuse cases, including patients with active, borderline, and absent myocarditis. The phenotypic expression of the lymphocytic infiltrates was similar to the findings reported for idiopathic and HIV-related myocarditis (Am J Pathol 137:1365-1371, 1990). Toxicology studies did not implicate any particular drug of abuse, but the increased frequency of myocarditis observed may reflect complications of cocaine or the combined effects of opiates and cocaine. Intravenous drug abuse is an independent risk factor for myocarditis and must be taken into consideration in studies of HIV-associated myocarditis.
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PMID:Incidental myocarditis with intravenous drug abuse: the pathology, immunopathology, and potential implications for human immunodeficiency virus-associated myocarditis. 174 Feb 98

In this article, we present data obtained with the psychosocial interview instrument, HEADSS (Home, Education, Activities, Drug use and abuse, Sexual behavior, Suicidality and depression) that was administered to High Risk Youth Clinic clients at their initial visits during a 1-year period. Of the 1,015 new patients, 63% were homeless/runaway youths and 37% were living with their families. Utilizing the HEADSS interview instrument, we compared homeless/runaway youths to nonhomeless youths in a number of areas, including risks for human immunodeficiency virus (HIV) infection. Our results showed that homeless teens tended to be younger, female, and white compared to their nonhomeless counterparts. They were more likely to have dropped out of school and were far more likely to be depressed and actively suicidal. They demonstrated all forms of drug abuse. They engaged in first sexual intercourse at an earlier age, and experienced a higher incidence of sexual abuse and prostitution. They were 6 times more likely to be at risk for HIV infection.
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PMID:HEADSS, a psychosocial risk assessment instrument: implications for designing effective intervention programs for runaway youth. 177 92

465 intravenous drug abuser (IVDA) women were studied to evaluate the prevalence of sexually transmitted diseases, 2207 university students have been considered as control group. A complete gynecological evaluation with Pap smear and cervico-vaginal cultures were performed. Informations on sexual and behavioural patterns were collected using a standard questionnaire. IVDAs show early onset of sexual activity (15 vs. 18 yrs) and many sexual partners; just a small percentage of them use condom, efficacious in the protection against venereal diseases. These peculiar behavioural patterns and the immunodeficiency ascribable to the drug abuse may condition the high frequency of viral and bacterial infections of lower genital tract (53% vs 0.8% and 67% vs 10% respectively). Cervical intraepithelial neoplasia has been found significantly more frequently in IVDA women (16%) than in control group (1%) p less than .01.
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PMID:[Sex behavior and sexually transmitted diseases in drug-dependent women: study of 465 cases]. 177 80

The seroprevalence of the human immunodeficiency virus (HIV) in 515 patients consecutively admitted to a state psychiatric hospital in New York City was 8.9%. There were 365 patients whose results were individually traceable; the remaining 150 patients were tested anonymously. Risk factors including parenteral drug abuse, male homosexual behaviors, and other sexual behaviors were studied in the traceable patients. Logistic regressions indicated that parenteral drug abuse was the main risk factor in both males and females. In females, two additional factors were significant: sex with parenteral drug users or with partners who have the acquired immunodeficiency syndrome (AIDS), and sex with bisexual men. Females with bipolar disorders were particularly likely to report sex with parenteral drug users or with partners who have AIDS.
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PMID:HIV seroprevalence and risk behaviors in psychiatric inpatients. 179 15

A case of recurrent multisystemic infection due to Rhodococcus equi in a patient with antibody to the human immunodeficiency virus (HIV) but without AIDS is reported. This case, which occurred in a woman with a history of alcohol and drug abuse, is, to our knowledge, the first such case described. The infection involved the lungs, kidneys, brain, and bloodstream. Despite several courses of therapy with antibiotics to which her isolates of R. equi were susceptible in vitro, the patient experienced multiple relapses before her death. On the basis of this case and a few others reported in HIV-infected patients, we recommend an initial antibiotic course at least 6-8 weeks in duration, and we suggest that combination antibiotic treatment be considered. We also suggest that infection with R. equi be included in the diagnostic criteria for AIDS.
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PMID:Relapsing systemic infection due to Rhodococcus equi in a drug abuser seropositive for human immunodeficiency virus. 186 57

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

As efforts targeted at producing an effective vaccine or a definitive cure are still in early stages of development, health education and prevention continue to be this country's major line of defense against acquired immunodeficiency syndrome (AIDS). This defense is dependent on knowledge of behaviors that place individuals at risk of human immunodeficiency virus (HIV) exposure and disease progression. This article reviews the critical points in our state of knowledge and offers additional areas of need. Research is needed to determine a database of persons who use psychoactive substances and to understand the HIV-associated behaviors linked to drug use. Epidemiologic studies are necessary to appreciate the sexual, contraceptive, and childbearing practices of users of any psychoactive substance. Greater emphasis also is needed to investigate the inherent effects of various psychoactive substances on the immune, neurologic, and endocrine systems. While biomedical research continues, it is apparent that research from behavioral studies are crucial to education and prevention efforts. Nurse investigators are well-positioned to play an important role in accumulating this information. Given the critical role of drug abuse in the HIV epidemic, the public health significance cannot be overestimated.
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PMID:AIDS-related behavioral research and nursing. 192 May 15

Development has been undertaken for microcomputer software intended to assess individual risk for HIV infection by analyzing personal case histories pertinent to drug abuse, receptive blood transfusion, and sexual behavior. The software performs interactive confidential interviews of individuals desiring expert assistance when deciding whether to commit to an antibody test. In the first phase of a validation study, 87 subjects responded to the computer interview. For each subject, human immunodeficiency virus (HIV) antibody status was on clinical record. This sample included 70 subjects, 29 of whom were HIV seropositive, recruited from the clientele of an AIDS antibody testing and counseling facility. In this phase, the software accurately assessed 28 of 29 seropositives (96.6%) to be at risk for HIV. The second phase was based upon participation of an additional 74 subjects who were undergraduates at the University of Oklahoma. In this presumed low-risk sample, 55 members reported never having previously tested for HIV antibodies. Seven members (12.7%) of the untested group were declared at risk in the course of receiving confidential computer screen advice. Of these 7, there were 3 members (42.9%) who were motivated by the computer to voluntarily seek HIV antibody testing. Of the 7 declared at risk, 2 members (3.9%) were among the 51 seronegative subjects classified as heterosexuals without specific and identified risks. All Phase II subjects seeking follow-up antibody tests were found seronegative.
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PMID:Risk assessment for HIV infection: validation study of a computer-assisted preliminary screen. 193 25


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