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Links between AIDS and self-injection of drugs were first recognized more than 20 years ago, but identification of a specific pathogen and ways to neutralize it has not led to complete success in preventing transmission of HIV-1 infection among injecting drug users (IDUs). A street ethnographer identified active risk locales (places where IDUs go to inject drugs) and recruited their proprietors into a study of contaminated injection paraphernalia. Collected paraphernalia from locales were analyzed for contamination by HIV-1 using real-time polymerase chain reaction (PCR). Proprietors and clientele of 16 risk locales participated by contributing used paraphernalia and/or agreeing to a blood test (0.5-1 mL drawn by finger stick). Real-time PCR was the primary measure used to determine contamination of injection paraphernalia and blood samples with HIV-1. Of 130 samples collected at baseline, a total of 8 were found to have evidence of HIV-1 contamination by detection of either HIV-1 RNA or DNA. The most serious contamination (up to 600,000 copies per milliliter) was found in ancillary paraphernalia, rather than needle/syringe (N/S) specimens. Only 4 of 74 N/S specimens had any evidence of HIV-1 contamination at all (with very low viral loads), and none had both HIV-1 DNA and RNA. Although IDUs in risk locales in Miami/Dade appear to be taking care of their N/S with regard to contamination by HIV-1, important evidence of contamination in ancillary paraphernalia, especially cookers and cottons, indicates that IDUs may still incur serious risk regardless of how well they care for their N/S. Our observations indicated that IDUs rinsed their N/S before returning them to the proprietors, from whom we eventually collected them, and this rinsing would have masked the contamination to which they were exposed through use of unrinsed cookers and reused cottons.

A mathematical model is developed to explore the relationship between the endemic HIV prevalence among injecting drug users and the coverage of syringe distribution. The results support a policy of increasing the coverage of syringe distribution but highlight the difficulty in producing a universal coverage target,

A molecular epidemiological study of HIV-1-infected injection drug users (IDUs) in Taiwan is conducted from January 2004 to April 2005. The information provided is relevant to the development of antiviral therapy and vaccine in Taiwan and might assist public health workers in the prevention of HIV-1 spread.

A community-based cross-sectional study among injection drug users (IDUs) in Vietnam assessed sexually transmitted disease (STD) prevalence and behavioral risk factors. It is found that high STD prevalence and high-risk sexual and parenteral behaviors among IDUs indicate the potential for HIV/STD transmission to the general Vietnamese population.

The combination of political, economic, and social changes that accompanied the fall of the Soviet Union has resulted in a dramatic epidemic of drug abuse in Russia, which has led to an epidemic of HIV-1, driven by injection drug use. The estimated HIV prevalence of 30% places St. Petersburg among the worst injection drug users concentrated epidemics in Europe.

Time-dependent and time-independent predictors of hepatitis C virus (HCV) RNA levels in 264 drug users with chronic HCV infection are studied. High levels of HCV RNA are associated with a poor response to treatment of chronic hepatitis C, and a substantial reduction in HCV RNA levels predicts a favorable treatment response.

Substance abuse, specifically the use of illicit drugs that are administered intravenously, continues to play a role in the transmission of human immunodeficiency virus type 1 (HIV-1) among adolescents and young adults (youth). Risks of HIV-1 infection may result from direct exposure to contaminated blood through sharing of injection drug equipment and from unsafe sexual practices (while under the influence of drugs and/or in exchange for drugs). Reducing the risk of HIV-1 infection that is associated with illicit drug use requires prevention education and prompt engagement in treatment. Providing patients with education, instruction on decontamination of used injection drug equipment, improved access to sterile syringes and needles, and postexposure prophylaxis may decrease their risk of acquiring HIV-1 infection. Pediatricians should assess risk behaviors as part of every health care encounter, including queries about tobacco, alcohol, and marijuana use. The risks and benefits of postexposure prophylaxis with antiretroviral drugs should be considered for youth with a single recent (within 72 hours) high-risk exposure to HIV-1 through sharing needles/syringes with an HIV-1-infected individual or having unprotected intercourse with an individual who engages in injection drug use. Such prophylaxis must be accompanied by risk-reduction counseling, appropriate referrals for treatment, and evaluation for pregnancy and associated sexually transmitted infections. There is an urgent need for more substance-abuse prevention and treatment programs, legislation that facilitates unencumbered access to sterile syringes, and expedient availability of reproductive health care services for sexually active youth, including voluntary HIV-1 counseling and testing. Key Words human immunodeficiency virus, HIV-1, adolescents, youth, substance abuse, injection drug use, postexposure prophylaxis, needle exchange Abbreviation PEP--postexposure prophylaxis, BACKGROUND Illicit drug use continues to play a major role in the transmission of human immunodeficiency virus type 1 (HIV-1) in the United States. Injection drug users, men who have [...]

The HIV status of the sex partners of injection drug users (IDUs) and rates of subsequent HIV seroconversion among a prospective cohort study of IDUs is evaluated. Having an HIV-positive sex partner was strongly and independently associated with seroconversion after adjustment for risk factors related to drug use.

We tested hypotheses that social living arrangement and drug use in one's network are independently associated with entry into opiate agonist treatment modalities. Injection drug users (IDUs) attending the Baltimore Needle Exchange Program who received a referral for drug abuse treatment were studied. Baseline interviews, HIV testing, and the Addiction Severity Index (ASI) were administered. Agency records were used to confirm entry into a treatment program offering opiate agonist maintenance therapy within 30 days of the baseline interview. Logistic regression was used to identify predictors of treatment entry. To date, of 245 IDUs, 39% entered such a program. Multivariate logistic regression models controlling for age and intervention status revealed that compared to individuals who lived alone, in a controlled, or nonstable environment (e.g., streets, abandoned house, transitional housing program, or boarding house), individuals who lived with a sexual partner were 3 times more likely to enter treatment (adjusted Odds Ratio [aOR]=3.04: p=0.013) and those who lived with family or friends were almost 3 times more likely to enter treatment (aOR=2.72; p=0.016). In the bivariate analyses, a marginal association was observed between being responsible for children or others and entry into treatment (p=0.066); however, this association was not significant in the multivariate model. Findings from this study suggest that supportive living environments may facilitate entry into treatment and may be helpful in devising appropriate and targeted interventions to encourage drug treatment entry. Keywords: Social network, living arrangement, treatment, injection drug users, INTRODUCTION Injection drug users (IDUs) represent the second largest risk group for HIV infection in the United States, accounting for approximately one-third of AIDS cases in the U.S. (1, 2). [...]

In North America, policy makers have responded to the HIV epidemic among injection drug users (IDUs) primarily by allocating resources to criminal justice interventions. Reliance on law enforcement has resulted […]

An analysis of the correlates of HIV status among samples of injection drug users (IDUs) in border region of Southern China and Northern Vietnam is presented and they are interviewed and tested for HIV antibody just before the start of a peer-based HIV prevention intervention in this border region. Logistic regression analysis suggests that among Chinese IDUs, border related factors and younger age are the best predictors of HIV positivity.

A study is done to identify prognostic indicators of survival at different CD$+ cell levels, independent of highly active antiretroviral therapy (HAART), among injection drug users (IDUs). The results showed that survival among HIV-infected IDUs improved since the introduction of HAART, even though utilization of HAART was incomplete.

Interventions to reduce risk behavior among injecting drug users (IDUs) have been conducted. Such interventions were no more likely to be effective than shorter interventions.

Byline: Susan Coventry (1,2), Lawrence R. Shoemaker (1) Keywords: collapsing glomerulopathy; focal segmental glomerulosclerosis; mycobacterium tuberculosis Abstract: Idiopathic collapsing glomerulopathy is an aggressive variant of focal segmental glomerulosclerosis (FSGS) seen primarily in adults. Its etiology is unknown. Nearly identical pathology is seen in association with nephrotic syndrome in human immunodeficiency virus type 1 (HIV-1)-infected patients, raising the possibility that viral infection plays a role in pathogenesis. This is supported by the recent discovery of parvovirus B19 DNA in some cases of idiopathic collapsing glomerulopathy. We report a case of collapsing glomerulopathy in a 16-year-old girl who presented with steroid-resistant nephrotic syndrome and pulmonary tuberculosis. In the absence of the usual associations (adult age group, African-American race, or history of intravenous drug abuse), infection is the sole known risk factor in this case. This lends support to the hypothesis that immune dysregulation due to infection per se, rather than infection by specific viral agents, may lead to collapsing glomerulopathy in susceptible individuals. Author Affiliation: (1) Department of Pathology, Kosair Children's Hospital, 231 E. Chestnut Street, Louisville, KY, 40202, USA (2) Department of Pediatrics, University of Louisville School of Medicine, 571 S. Floyd Street, Suite 300, Louisville, KY, 40202, USA Article History: Registration Date: 01/01/2003 Received Date: 12/03/2003 Accepted Date: 13/11/2003 Online Date: 17/03/2004

Research has been conducted on relationship between early shooting gallery attendance and HIV prevalence among young adult and adolescent injection drug users. Results demonstrate that young new injection drug users attending early shooting gallery tend to be initiated by older high-risk injection drug users, and that HIV may be transmitted from the older group of injection drug users to the younger one.

Research has been conducted on medically supervised injection facilities. Results demonstrate that due to ongoing health crisis among injection drug users in different Canadian cities these people are willing to attent medically supervised safer injection facilities.

Research has been conducted on the role of social instability in adherence to highly active antiretroviral therapy among HIV patients infected via injection drug use. The authors have analyzed sociodemographic baseline characteristics in order to develop social instability indicator, and the details are reported.

Research has been conducted on HIV infection prevalence and risk behaviors among young injection drug users in San Francisco. Results demonstrate that HIV infection prevalence is highest among male injection drug users who have sex with men.

Research has been conducted on the neuroendocrine abnormalities in general and HPA axis activity in both HIV-1 infection and chronic drug users. The mechanisms involved in the neuroendocrine abnormality development in HIV-infected injection drug users have been investigated and the results are reported.

Research has been conducted on the metabolic disorders caused by HIV infection. The diagnosis, underlying pathophysiology, prevalence, risk factors and prevention and treatment of such HIV metabolic complications and drug abuse as glucose abnormalities, lipid metabolism disorders and wasting have been investigated and are discussed.

Research has been conducted on the HIV encephalitis and drug use intersecting pathology. The study of this pathology has been carried out via the analysis of the full autopsy-derived HIV-infected human tissues accumulated in the HIV Brain and Tissue Bank in UK with the aim of determining the relationship of HIV-related complications in the nervous system with the risk group of infected patients.

Research has been conducted on the syringe exchange program effectiveness in preventing HIV infection and HIV risk behavior among injection drug users. Results prove that syringe exchange has a substantial protective effect against HIV risk behavior and is critical for the injection drug users without other syringe sources.

Research has been conducted on the HIV spread in a large U.S. city. The use of the social network data in forecasting HIV spread and the use of the information on risk relationship which includes the frequency and the type of opposite-sex behaviors and illegal grug injection behaviors are discussed.

The authors examine the possible link between drinking alcohol and drug risk taking behaviors among intravenous drug users. Topics include risk of HIV infections, risk taking following drinking, and health risks associated with needle exchanging.

Research has been conducted on HIV prevalence and incidence trends. The aim of the study has been to document these trends and associated risk factors among injection drug users in Eastern Central Canada, and the results demonstrate that HIV continue to be transmitted among injection drug users in this region.

Research has been conducted on the HIV prevalence and HIV infection risk factors among young injection drug users. Results demonstrate that HIV positivity among young injection drug users concentrates among females engaged in sexual and drug-related risk exposure activities.

The authors estimate HIV incidence, HIV transmission temporal trends and HIV seroconversion correlates among patients tested for HIV by a San Francisco county hospital. Results demonstrate that the seroconversion rate in this hospital is very high and that HIV transmission among injection drug users has not decreased over the years.

Research has been conducted on the use of antiretroviral therapy by HIV-infected injection drug users, including women. The authors report that at the on-site care centers women are likely to report antiretroviral therapy use regardless of injection drug use, whereas at referral sites only sexual contact identified women report any antiretroviral therapy use.

Byline: S. Brunner (1), F. Fleisch (2), C. Ruef (2), M. Altwegg (1) Keywords: Key Words Invasive group A streptococci; Intravenous drug abuse; Ribotyping; Pulsed-field gel electrophoresis Abstract: Background: In 1998, an unexpected increase of group A streptococci (GAS) in blood cultures was observed at our institution. Materials and Methods: To determine whether they were from unrelated sporadic cases or attributable to a common source, all isolates were analyzed by pulsed-field gel electrophoresis (PFGE) and by automated ribotyping. Results: Two clusters were found. All isolates, except one, of cluster 2 had been isolated from intravenous drug abusers. Conclusion: All patients were hospitalized either in different hospitals or at different times in the same hospitals indicating that the putative common source is to be found in the drug community rather than in a particular hospital. Author Affiliation: (1) Dept. of Medical Microbiology, University of Zurich, Gloriastr. 32, CH-8028 Zurich, Switzerland, Phone: (+41/1) 634-2752, Fax: -4906, e-mail: sbrunner@immv.unizh.ch, CH (2) Div. of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, HAL 14C, CH-8091 Zurich, Switzerland, CH Article note: Received: January 13, 2000 * Revision accepted: June 27, 2000