Highly active antiretroviral therapy outcomes in a primary care clinic.

This paper compares antiretroviral outcomes of patients at a primary care clinic with those previously reported at HIV specialty clinics and examines risk factors for treatment failure. A retrospective medical record review was undertaken at an academic primary care practice in Baltimore, Maryland. One hundred and twenty-three patients were included who had not previously received HAART and who were started on a regimen that included a protease inhibitor or a non-nucleoside reverse transcriptase inhibitor and at least one other new antiretroviral medication. HIV RNA levels, CD4 lymphocyte counts, missed appointment rate, HAART regimen, demographic variables, and their association with the achievement of a viral RNA of 500 or less at 7-14 months were analyzed. Forty-seven per cent of the patients had an HIV RNA level of 500 or less at 7-14 months after initiation of HAART. Factors associated with treatment failure included missed appointment rate, injection drug use and previous exposure to antiretroviral medication. On multivariate analysis, only missed appointment rate and lower baseline CD4 lymphocyte count were independently associated with treatment failure. The antiretroviral outcomes of patients started on HAART by experienced health care providers in this primary care practice were comparable to those reported in specialty clinics. As with previous reports, most patients did not maintain viral suppression. Missed appointment rate was the most important risk factor for treatment failure.

Full recovery from severe dilated cardiomyopathy in an HIV-infected patient.

HIV-related cardiomyopathy is usually seen in persons with advanced HIV disease and carries a very poor prognosis. Severe dilated cardiomyopathy necessitating hospitalization in the cardiac ICU with vasopressor and ventilator support developed in a 44-year-old HIV-infected man with a CD4+ cell count of 552/microL and an undetectable plasma HIV RNA level who was treated with didanosine and hydroxyurea. During the course of a year, he had full recovery of cardiac function. Aggressive intervention is warranted in otherwise healthy HIV-infected patients presenting with severe dilated cardiomyopathy.

One-, three-, and six-month outcomes after brief inpatient opioid detoxification.

The purpose of this study was to investigate short-term outcomes of a 3-day inpatient medical detoxification. Heroin abusers (n = 116; 66% male, 77% African-American, X = 38 years old), completed the Addiction Severity Index during detoxification, and at 1, 3, and 6 months after detoxification; 94.5% of the postdetoxification interviews were completed. During the 30 days before detoxification, mean days of self-reported use for heroin was 28, for cocaine 19, and for alcohol 14; a mean of $1,975 was spent on drugs. Across the postdetoxification interviews, mean days of reported heroin use ranged from 11 to 14; 21-30% of patients reported no heroin use, whereas 25-36% reported almost daily use. Reported use of cocaine and alcohol showed similar reductions from pre- to postdetoxification. Reports of heroin and cocaine abstinence were generally verified through urine tests. Other psychosocial factors improved as well from pre- to postdetoxification (e.g., employment increased and needle use decreased). During the 6-month evaluation, at least 41% reported engaging in formal inpatient or outpatient treatment; another 25-33% reported attending self-help groups. Engaging in formal treatment (at least 7 days duration) was associated with significantly better outcome. Nevertheless, pre- to postdetoxification changes were significant and robust for the entire study sample. These findings demonstrate that brief inpatient detoxification is followed by reduced drug use over several months and is accompanied by substantial treatment-seeking behavior. Thus brief detoxification may serve as an effective harm-reduction intervention.

Personality characteristics of treatment-seeking HIV+ pregnant drug dependent women.

Pregnant, drug dependent women present for treatment with a variety of medical and psychosocial issues. When medical sequelae include HIV infection, effective medical and psychosocial management is essential for both mother and fetus/infant. To better understand and characterize this high-risk population, the present study examined personality features and psychopathology in a sample of HIV+, pregnant, drug dependent women. Personality was assessed using the Minnesota Multiphasic Personality Inventory--Revised (MMPI-2). The mean MMPI-2 codetype, (6-8), although relatively rare in standard drug treatment settings, characterized nearly one-fifth of study participants. The 6-8 codetype is typically associated with unusual thought processes, feelings of hostility and suspiciousness as well as apathy, which may mask symptoms of nervousness, anxiety and depression. Treatment implications of study findings are discussed.

Abuse liability of testosterone.

Anabolic-androgenic steroids (AAS) are used by athletes to enhance performance and physique. Case reports and observations propose that AAS have mood elevating properties and that chronic use leads to addiction. The aim of this study was to evaluate the subjective and physiological effects of single doses of testosterone. In a double-blind fashion, according to a balanced Latin square, 10 paid adult male volunteers received doses of i.m. testosterone (50, 100 and 200 mg), morphine (10 mg) or placebo for five consecutive days. Subjective and physiological responses were measured during each drug condition. Testosterone produced no significant changes in self-reported or observed measures, unlike morphine, which produced statistically significant changes in several measures, including 'feel the drug', 'like the drug' and 'feel high'. There were no adverse effects of administering high doses of testosterone. In conclusion, single doses of testosterone are devoid of the usual pharmacologic effects that are associated with abuse.

Prevalence of hepatitis C in a chemically dependent population.

BACKGROUND: Drug abuse is the major risk factor for hepatitis C in the United States. The objective of this study was to determine the prevalence of hepatitis C virus (HCV), to identify risk factors for HCV, and to correlate HCV and liver function in patients presenting for inpatient detoxification of substances of abuse. METHODS: A total of 687 patients were tested for the presence of antibody to HCV (anti-HCV). Histories related to drug use, sexually transmitted diseases, blood transfusion, and human immunodeficiency virus were obtained, as were serum tests for human immunodeficiency virus, syphilis, hepatitis B, aminotransferases, total bilirubin, and alkaline phosphatase. RESULTS: The overall prevalence of anti-HCV was 63%: 68% in men vs 54% in women (P < .001), with no difference by race. Remarkably, 86% of injecting drug users tested positive for anti-HCV. Identified risk factors for anti-HCV were injecting drug use (P < .001), human immunodeficiency virus infection (P = .003), exposure to hepatitis B virus (P < .001), and a positive rapid plasma reagin test (P = .04). Previous transfusion and history of previous infection with gonorrhea or syphilis did not correlate with the presence of anti-HCV. Patients positive for anti-HCV had significant elevations in aspartate aminotransferase and alanine aminotransferase levels when compared with patients negative for anti-HCV: 50.8 vs 36.7 U/L (P = .002) and 56.0 vs 36.9 U/L (P < .001), respectively. CONCLUSION: Injecting drug users have an extremely high prevalence of anti-HCV. This is the first demonstration, to our knowledge, that the presence of anti-HCV in drug users is associated with significantly increased levels of serum aminotransferases.