From the Alcohol, Drug Abuse, and Mental Health Administration: serious infections other than human immunodeficiency virus among intravenous drug abusers

Article Abstract:

A technical review meeting held at the National Institute on Drug Abuse brought together experts to discuss the various infections which are being spread by intravenous drug abuse. Since AIDS has received so much attention from other sources, the meeting limited itself to infections other than HIV. Viral hepatitis is on the rise, and much of the increase may be attributed to IV drug use. Viral hepatitis is exceeded only by gonorrhea among the reportable diseases in the United States, and hepatitis B continues to increase in incidence despite a vaccine which has been available for eight years. Both gonorrhea and syphilis are prevalent among IV drug users, which may be the result of the increased use of prostitutes by this group and the practice by some women of exchanging sex for drugs. Endocarditis, or the infection of the lining of the heart, is not a reportable disease but it is clearly a significant cause of sickness and death among IV drug users, accounting for between 8 and 16 percent of hospital admissions of drug users and as many as 8 percent of the deaths in this group. Intravenous drug users are also liable to develop fungal meningitis, brain abscesses, and other disorders of the central nervous system. The majority of brain diseases are not reportable, and it is therefore difficult to obtain precise statistics on the incidence of these disorders among IV drug users. Drug abusers are also likely to become infected with the human T-cell leukemia viruses, types I and II (HTLV-I and HTLV-II). These retroviruses seem to be associated with some cases of T-cell leukemia, but the precise nature of the association is uncertain, and only a minority of infected individuals develop disease. More research is required into the consequences of HTLV infection. After more than three decades of decline, tuberculosis is again on the rise, but much of this rise is due to the reactivation of latent infection by infection with HIV. The participants in the meeting agreed that the medical problems associated with drug abuse should receive more attention from health care practitioners, that drug abusers should be convinced not to use hypodermic injection, and that, when possible, IV drug abusers should be enrolled in programs which may help them to abandon their habit. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Infection, Complications and side effects, Statistics, Intravenous drug abuse

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Comparison of saliva and blood for human immunodeficiency virus prevalence testing

Article Abstract:

For most purposes, the presence of antibodies is usually determined by analyzing venous blood. While appropriate for diagnostic purposes, an alternate specimen that would eliminate the use of needles is desirable for identifying the presence of antibodies to human immunodeficiency virus (HIV), which causes AIDS. Saliva, if suitable for antibody testing, meets the criteria for epidemiologic studies: ease of collection, no venipuncture required, reduced risk of viral transmission, and minimal personnel training necessary. Sera (blood) and saliva were collected from 182 sexual contacts of patients with AIDS or AIDS-related-complex (ARC). Dried blood and/or saliva specimens were collected from 361 intravenous drug users (IVDUs) participating in a needle exchange project. After modification of the techniques, all specimens were tested by ELISA (enzyme-linked immunoabsorbent assay) and immunoblot analyses for the presence of antibody to HIV. The overall agreement between results obtained for saliva and serum or dried blood was 574 out of 576 (99.6 percent). The final sensitivity was 98.3 percent and the final specificity was 100 percent. (Sensitivity and specificity, used here, describe the defined capabilities of the test procedure to confirm the presence and the absence, respectively, of antibodies in saliva, compared with the same parameters in sera and dried blood.) The advantages of using saliva for monitoring HIV infection and for conducting epidemiologic studies outweigh the relatively small loss in sensitivity. The results also indicate that individuals at risk for HIV infection were more willing to provide saliva specimens. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Testing, Medical examination, HIV infection, HIV infections, HIV patients, Identification and classification, Saliva, HIV seropositivity, HIV positive, HIV antibodies

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Urbs in Rure: Human immunodeficiency virus infection in rural Tennessee

Article Abstract:

The distribution of 81 cases of acquired immunodeficiency syndrome (AIDS) in a rural community of 50,000 people (Johnson City, TN) is described. The usual spectrum of high-risk persons is represented: gay males and their sex partners, intravenous drug users, hemophiliacs and other transfusion recipients. No other heterosexual cases are reported. Most of the cases were native to the area. Travel was infrequent, and many who acquired the infection away from home returned for care and social support. One such case, previously reported as missing, was welcomed back first with apprehension, then with thorough family and community support. Support from the family was more beneficial than education efforts of professionals. The rural gay society exhibits more circumspect sexual and social behavior than its urban counterpart. The need for expanding rural services and education for these AIDS cases is becoming more apparent. Both physicians and families require reinforced education to meet the future needs and responsibilities for prevention efforts, and care needs for expanding AIDS caseloads. (Consumer Summary produced by Reliance Medical Information, Inc.)

HIV (Viruses), HIV, Disease transmission, AIDS (Disease), Rural health, editorial

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