Blood and plasma donations among a cohort of intravenous drug users

Article Abstract:

Preventing the transmission of acquired immunodeficiency syndrome (AIDS) through blood and blood products is a necessity. In March 1985 a blood and plasma screening program was begun to detect antibodies to HIV-1 (human immunodeficiency virus, type 1, the virus associated with AIDS). Another approach to ensuring the safety of blood and blood products has been the voluntary deferral of high-risk individuals, a program that has gained wide acceptance among homosexual and bisexual potential blood donors. However, intravenous drug users (IVDUs), a high risk group for HIV and AIDS, may donate blood to receive the fees offered by some donation centers. To assess the prevalence of blood and plasma donation by IVDUs, 2,921 IVDUs were studied. The subjects were enrolled in a natural history study of HIV-1 infections called ALIVE (AIDS Link to Intravenous Experiences) and were predominantly male and black. Most used both heroin and cocaine, and had used illicit drugs for 12 years. Subjects answered questionnaires regarding drug habits, sexual practices, demographic and socioeconomic data, medical history, and history of blood or plasma donation. Blood banks in the region where the study was carried out do not pay donors, but commercial plasma centers pay between $10 and $15 per donation. All blood donation centers screen for HIV-1 antibodies and maintain donor deferral lists, which are based on medical history and laboratory results of tests for hepatitis and other diseases. These lists are not shared. Results of the study indicated that 793 participants (27.1 percent) had donated blood or plasma between 1978 and 1988, with 97 people having last donated one year or more before they began injecting drugs. Approximately 82 percent, however, had been injecting drugs for at least one year when they last donated blood. Since 1985, when routine HIV-1 screening began, 437 participants had donated blood, with the majority going to a commercial center. Forty-eight (11.0 percent) of those reporting donations since 1985 tested positive for HIV-1 antibody when they enrolled in ALIVE (a rate lower than the overall rate of subjects in the ALIVE study). The number of individuals who tested positive for HIV-1 virus declined as the time between the baseline HIV-1 screening and the last donation became shorter; only 3.6 percent of those who had donated most recently were HIV-positive. These findings indicate that screening programs have been effective in decreasing HIV contamination of blood donations, and that the rate of seropositivity among blood donors has decreased substantially in recent years. (Consumer Summary produced by Reliance Medical Information, Inc.)

Risk factors, Surveys, Study and teaching, Drug abuse, Donation of organs, tissues, etc., Tissue donation, Blood donors, Blood donation, Drug education

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Human immunodeficiency virus infection in diabetic intravenous drug users

Article Abstract:

Intravenous (IV) drug users often suffer from illnesses related to injection practices, socioeconomic status and risky behavior. IV drug users are more likely to be infected with human immunodeficiency virus (HIV), as well as other bloodborne diseases. The only exceptions to this observation are IV drug users with diabetes mellitus. To determine the relation between diabetes and HIV infection, 2,921 IV drug users, including 41 (1.4 percent) diabetics, were recruited to participate in this study. It was found that diabetic IV drug users were less likely to be infected with HIV. Diabetic IV drug users more often reported that they did not share needles and syringes, and that they were ''absolutely sure'' that no one had used the drug paraphernalia before they did. Frequenting ''shooting galleries,'' where needles are ''rented,'' was less common among diabetics than among nondiabetics. The most probable explanation for the lower infection rate is that diabetics have better access to sterile injection equipment, suggesting that easing restrictions on access to this equipment may slow the spread of HIV infection. This issue has been discussed in public health debates, but the absence of information about the effectiveness of needle exchange programs has prevented them from being implemented. This study suggests that a needle exchange policy may be effective in preventing the spread of HIV. (Consumer Summary produced by Reliance Medical Information, Inc.)

Demographic aspects, Diabetics, HIV (Viruses), HIV, Disease transmission

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Prevalence of tuberculin positivity and skin test anergy in HIV-1-seropositive and -seronegative intravenous drug users

Article Abstract:

A survey of 2,921 intravenous drug abusers in Baltimore, MD found that 20.4% had a positive reaction to a PPD tuberculin test. When a 5 millimeter induration was used as the cutoff -- the CDC's standard -- 25.2% of drug abusers who were HIV-1-seronegative reacted to the test compared to 13.8% of HIV-1-seropositive individuals. HIV-1-seropositive and -seronegative refer to individuals who have antibodies to HIV-1 -- the AIDS virus -- in their blood and those who do not. When a 2 millimeter induration was used as the cutoff, more HIV-1-seropositive individuals were PPD positive. Tuberculosis could be underdiagnosed in HIV-1-seropositive individuals if the CDC's guideline is used. HIV-1-seropositive individuals were also more likely to be anergic, that is, they did not respond to skin tests using foreign antigens. Any HIV-1-seropositive individual with a negative PPD should also be tested for anergy.

Usage, Testing, Tuberculin test

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