Recreational drugs of abuse.

The use of recreational drugs of abuse continues to expand without limitations to national boundaries, social status, race, or education. Beyond the prevalence of illicit drug use and dependence, their contribution to the global burden of disease and death are large and troubling. All medical providers should be aware of the evolving drugs of abuse and their medical and social consequences. In addition to heroin and stimulants such as cocaine and methamphetamine, new designer stimulants called "bath salts" and cannabinoids called "spice," along with the abuse of prescription drugs and volatile substances, are now widely recognized problems in many societies. The wide variety and continuingly expanding clinical manifestations of toxicity of recreational drugs of abuse is not widely appreciated by clinicians. This edition attempts to summarize six major classes of drugs of abuse and their clinical effects with special emphasis on their immunological and respiratory effects.

The effects of a harm reduction housing program on the viral loads of homeless individuals living with HIV/AIDS.

Although the advent of highly active antiretroviral therapies has increased survival rates for many individuals living with HIV/AIDS, chronically homeless individuals with the disease continue to experience poor clinical outcomes and high mortality rates in comparison to the general population living with HIV. Housing as a structural intervention for homeless people living with HIV/AIDS has been shown both to be feasible and to improve access to care. However, few studies report the impact of accessing stable housing on residents' viral load counts, even though viral load has been accepted as the best predictor of clinical prognosis for over a decade. The Open Door is a nonprofit agency that utilizes a harm reduction, housing first model of care to improve clinical outcomes for homeless people living with HIV. This article describes the first study that utilizes viral load to assess the effectiveness of a housing first approach. During the study period, we found that 69% of residents of The Open Door achieved undetectable viral loads, which far exceeds adherence rates ranging from 13 to 32% that were found in other studies of similar vulnerable populations. This finding supports the feasibility of this approach and its potential impact on reducing HIV morbidity, mortality, and secondary transmission. Given that the majority of the residents were active substance users during the study period and achieved undetectable viral loads, our findings also substantiate other studies demonstrating that substance users are able to maintain clinical adherence.

Designing immunotherapies to thwart drug abuse.

Immunotherapy for treating illicit drug abuse is a rapidly advancing field. There are currently two major approaches to developing drug-specific immunotherapies: active and passive. Active immunotherapy involves conjugating a drug-like hapten to a carrier protein and using traditional immunization approaches to generate a drug-specific immune response in the patient. In contrast, passive immunotherapy utilizes preformed monoclonal antibodies. Whether generated by active immunization or delivered passively, antibodies act as pharmacokinetic antagonists by binding the drug in the blood-stream and reducing the amount and rate of drug delivery to receptors in the brain. A newly emerging technology in anti-drug immunotherapy is the use of antibody fragments, or scFvs, rather than intact immunoglobulin G (IgG). These scFvs can retain the same binding properties as the original mAbs, and are onethird the molecular weight, providing a scaffold for creating antibody treatments with more customizable properties. Another nascent area of research utilizing the scFv scaffold is in creating drug-specific scFv-nanoparticle conjugates. These conjugates could improve upon current drug-specific antibody paradigms by increasing multivalency and allowing pharmacokinetic customization, while avoiding interactions with endogenous antibody receptor pathways. These parallel approaches to immunotherapy are moving rapidly toward the clinic and may soon provide new therapies for treating drug abuse.

Multidisciplinary baseline assessment of homosexual men with and without human immunodeficiency virus infection. II. Standardized clinical assessment of current and lifetime psychopathology.

Despite numerous reports of the psychiatric consequences of human immunodeficiency virus infection, few reports describe systematic diagnostic assessments of people with human immunodeficiency virus infection. We studied the results of standardized clinical assessments of current and lifetime psychopathology in a large group of homosexual men whose serologic status was known. Results indicated low rates of current mental disorders but very high rates of lifetime major depression and alcohol and other psychoactive substance abuse and dependence disorders. Measures of severity of psychopathology and functioning also indicated, on the whole, good current functioning. No significant relationship was found between stage of medical illness or immune status and any measure of psychiatric disturbance.

Assessment of platelet antibody by flow cytometric and ELISA techniques: a comparison study.

Two different methods for evaluating platelet antibody were used to study 12 normal subjects and 24 patients consisting primarily of intravenous drug users (IVDUs) who were positive for human immunodeficiency virus (HIV). Total platelet-associated immunoglobulin G (IgG) and immunoglobulin M (IgM) were measured by enzyme-lined immunosorbent assay on platelet lysate, and platelet surface-associated IgG and IgM were measured by semiquantitative flow cytometry. IgG and IgM values showed significant correlations between the two measurement methods. Mean platelet surface IgG and total IgG were 3.6 and 4.3 times greater, respectively, in IVDUs than in controls, and platelet IgM was also significantly higher in IVDUs than in controls as measured by both techniques. Although mean platelet immunoglobulin levels were higher in the IVDUs with thrombocytopenia than in IVDUs with normal platelet counts, these differences did not achieve significance. These data show that platelet IgG and IgM levels are increased in IVDU-associated HIV infection and suggest that these increases are not confined to patients manifesting thrombocytopenia. The herein described platelet surface antibody and total platelet antibody measurements appear to be equally useful in studying this patient population. Specific details for generating platelet-associated immunofluorescence units are discussed.