AIDS in intravenous drug users: issues related to enrollment in clinical trials

Article Abstract:

Most of the clinical trials regarding treatment of HIV-infected individuals have enrolled white homosexual men as the subjects. But the clinical course of infection and progression to AIDS in this group of individuals may be very different from that in other populations, including women, minorities, and those with a history of intravenous drug use. These other populations must also be included in clinical trials. The second most common method of acquiring AIDS, after homosexual contact, is through the use of intravenous drugs. Intravenous drug use is associated with more than 27 percent of the total number of AIDS cases, and with more than 50 percent of the cases in women and 75 percent of the cases in children. Black Americans and Latinos have a greater incidence of intravenous drug use, and thus HIV infection acquired from this behavior. The incidence of drug use in the inner cities is extremely high, and it is difficult to reach these individuals to offer treatment for HIV infection and substance abuse. Psychological support must be given as well. In the past, there has been a lack of coordination between the drug treatment and health care systems. In Boston City Hospital, there is an adult immunodeficiency clinic for the homeless. The program is coordinated with the city's drug treatment program. This hospital has also established an immunodeficiency clinic for children. These clinics can serve as models for other clinics that are being established around the country. Additional research is needed concerning intravenous drug users who have AIDS. Questions that must be answered include: how does methadone affect the antiviral treatments used for AIDS; how will women be affected by treatment with antivirals; and how does intravenous drug use affect the blood cell markers used to determine the state of immunodeficiency? Although individuals using intravenous drugs may not be reliable for participation in clinical trials, those who are receiving treatment for drug use may be reliable. A set of favorable and unfavorable signs for compliance of intravenous drug users in clinical trials have been established; these signs can be used when considering whether an intravenous drug user should be enrolled in a clinical trial. (Consumer Summary produced by Reliance Medical Information, Inc.)

Medical care, Demographic aspects, AIDS (Disease) in children, Pediatric AIDS (Disease), Intravenous drug abuse, Virus-induced immunosuppression

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Use of paper-absorbed fingerstick blood samples for studies of antibody to human immunodeficiency virus type 1 in intravenous drug users

Article Abstract:

As of February 1989, intravenous drug abuse alone or with other risk factors accounted for 36,493 (about 30 percent) of the AIDS cases reported in the United States. Testing for antibodies to human immunodeficiency virus type 1 (HIV-1) provides an accurate means of determining rates of seroprevalence (number of people who have antibodies to the virus) and HIV infection. The findings of such tests may be helpful in developing prevention and educational programs aimed at various high-risk groups. Seroprevalence rates among intravenous drug users (IVDU) vary by geographic region and drug use behaviors, such as needle sharing. If testing for HIV antibodies could be performed reliably on a broader scale, the incidence of seroprevalence among IVDUs could be accurately determined. Venipuncture samples (blood obtained from a vein) are difficult to obtain from IVDUs; paper absorbed (PA) fingerstick samples may be a convenient alternative for extensive trials and surveys of seropositivity. (A seropositive or HIV-positive result indicates HIV infection.) This method of collecting blood samples has been successful in large scale newborn studies and some smaller trials with adults. Both PA fingerstick and venipuncture blood samples were collected from 393 IVDUs participating in a drop-in counselling program. PA samples were collected from 145 participants in a methadone treatment program. Serum samples were tested by enzyme immunoassays (EIA) and immunoblot (IB) assays. PA samples were eluted, and the eluates (water soluble material) were tested by EIA. Testing for HIV-1 antibodies by the PA fingerstick method produced results that were qualitatively equal to those of the serum antibody assays. The PA fingerstick method may be useful in large scale HIV surveys and screening programs. Obtaining blood specimens by this method is convenient, less expensive, and safer. PA fingersticks also facilitate specimen storage, transport and processing. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Testing, Risk factors, Medical examination, HIV patients, Drug abuse, Blood, HIV seropositivity, HIV positive, Blood tests

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Response of lymphoepithelial parotid cysts to antiretroviral treatment in HIV-infected adults

Article Abstract:

Many of the commonly used AIDS drugs may be effective in treating cysts in the parotid glands. The parotid glands are located in the cheeks and produce saliva. Researchers followed nine HIV-infected patients who were taking various AIDS drugs, including zidovudine, didanosine, stavudine and protease inhibitors. The cysts completely disappeared in six patients and three patients had a partial response.

Evaluation, Abnormalities, Drug therapy, Antiviral agents, Parotid glands, Cysts

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