CCR6 mediates dendritic cell localization, lymphocyte homeostasis, and immune responses in mucosal tissue

Chemokine-directed migration of leukocyte subsets may contribute to the qualitative differences between systemic and mucosal immunity. Here, we demonstrate that in mice lacking the chemokine receptor CCR6, dendritic cells expressing CD11c and CD11b are absent from the subepithelial dome of Peyer's patches. These mice also have an impaired humoral immune response to orally administered antigen and to the enteropathic virus rotavirus. In addition, CCR6(-/-) mice have a 2-fold to 15-fold increase in cells of select T lymphocyte populations within the mucosa, including CD4+ and CD8+ alphabeta-TCR T cells. By contrast, systemic immune responses to subcutaneous antigens in CCR6(-/-) mice are normal. These findings demonstrate that CCR6 is a mucosa-specific regulator of humoral immunity and lymphocyte homeostasis in the intestinal mucosa.

Anisotropy of Young's modulus of human tibial cortical bone

The anisotropy of Young's modulus in human cortical bone was determined for all spatial directions by performing coordinate rotations of a 6 by 6 elastic stiffness matrix. The elastic stiffness coefficients were determined experimentally from ultrasonic velocity measurements on 96 samples of normal cortical bone removed from the right tibia of eight human cadavers. The following measured values were used for our analysis: c11 = 19.5 GPa, c22 = 20.1 GPa, c33 = 30.9 GPa, c44 = 5.72 GPa, c55 = 5.17 GPa, c66 = 4.05 GPa, c23 = 12.5 GPa. The remaining coefficients were determined by assuming that the specimens possessed at least an orthorhombic elastic symmetry, and further assuming that c13 = c23 c12 = c11 - 2c66. Our analysis revealed a substantial anisotropy in Young's modulus in the plane containing the long axis of the tibia, with maxima of 20.9 GPa parallel to the long axis, and minima of 11.8 GPa perpendicular to this axis. A less pronounced anisotropy was observed in the plane perpendicular to the long axis of the tibia. To display our results for the full three-dimensional anisotropy of cortical bone, a closed surface was used to represent Young's modulus in all spatial directions.

Site-directed mutagenesis of 2,4-dichlorophenoxyacetic acid/alpha-ketoglutarate dioxygenase. Identification of residues involved in metallocenter formation and substrate binding

2,4-dichlorophenoxyacetic acid (2,4-D)/alpha-ketoglutarate (alpha-KG) dioxygenase (TfdA) is an Fe(II)-dependent enzyme that catalyzes the first step in degradation of the herbicide 2,4-D. The active site structures of a small number of enzymes within the alpha-KG-dependent dioxygenase superfamily have been characterized and shown to have a similar HXDX(50-70)HX(10)RXS arrangement of residues that make up the binding sites for Fe(II) and alpha-KG. TfdA does not have obvious homology to the dioxygenases containing the above motif but is related in sequence to eight other enzymes in the superfamily that form a distinct consensus sequence (HX(D/E)X(138-207) HX(10)R/K). Variants of TfdA were created to examine the roles of putative metal-binding residues and the functions of the other seven histidines in this protein. The H167A, H200A, H213A, H245A, and H262A forms of TfdA formed inclusion bodies when overproduced in Escherichia coli DH5alpha; however, these proteins were soluble when fused to the maltose-binding protein (MBP). MBP-TfdA exhibited kinetic parameters similar to the native enzyme. The H8A and H235A variants were catalytically similar to wild-type TfdA. MBP-H213A and H216A TfdA have elevated K(m) values for 2,4-D, and the former showed a decreased k(cat), suggesting these residues may affect substrate binding or catalysis. The H113A, D115A, MBP-H167A, MBP-H200A, MBP-H245A and MBP-H262A variants of TfdA were inactive. Gel filtration analysis revealed that the latter two proteins were highly aggregated. The remaining four inactive variants were examined in their Cu(II)-substituted forms by EPR and electron spin-echo envelope modulation (ESEEM) spectroscopic methods. Changes in EPR spectra upon addition of substrates indicated that copper was present at the active site in the H113A and D115A variants. ESEEM analysis revealed that two histidines are bound equatorially to the copper in the D115A and MBP-H167A TfdA variants. The experimental data and sequence analysis lead us to conclude that His-113, Asp-115, and His-262 are likely metal ligands in TfdA and that His-213 may aid in catalysis or binding of 2,4-D.

Effects of cannabinoid receptor agonist and antagonist ligands on production of inflammatory cytokines and anti-inflammatory interleukin-10 in endotoxemic mice

Previous studies have shown that mice primed with Corynebacterium parvum produce higher levels of inflammatory cytokines than unprimed mice upon challenge with lipopolysaccharide (LPS). Herein, we describe experiments in which two cannabinoid (CB) agonists, WIN 55212-2 [(R)-(+)-[2, 3-dihydro-5-methyl-3-[(4-morpholinyl)methyl]pyrrolo[1,2,3-de]1, 4-benzoxazin-6-yl](1-naphthyl)methanone) and HU-210 [(-)-11-hydroxy-delta(8) tetrahydrocannabinol-dimethylheptyl], were examined for their effects on LPS-induced cytokines in C. parvum-primed and unprimed mice. These agonists have been reported to bind selectively to the CB2 and CB1 receptor subtypes, respectively. WIN 55212-2 (3.1-50 mg/kg i.p.) and HU-210 (0.05-0.4 mg/kg i.p.) decreased serum tumor necrosis factor-alpha and interleukin-12 (IL-12) and increased IL-10 when administered to mice before LPS. The drugs also protected C. parvum mice (but not unprimed mice) against the lethal effects of LPS. The protection afforded to C. parvum mice could not be attributed to the higher levels of IL-10 present in these mice after agonist treatment. The WIN 55212-2- and HU-210-mediated changes in the responsiveness of mice to LPS were antagonized by SR141716A [N-(piperdin-1-yl)-5-(4-chloropheny)-1-(2, 4-dichloropheny)-4-methyl-1H-pyrazole-3-carboxamide hydrochloride], a selective CB1 receptor antagonist, but not by SR144528 [N-[(1S)-endo-1,3,3-trimethylbicyclo[2.2. 1]heptan-2-yl]5-(4-choro-3-methylphenyl)-1-(4-methylbenzyl)p yrazole-3 -carboxamide], a selective antagonist at the CB2 receptor. Therefore, both CB agonists modulated LPS responses through the CB1 receptor. Surprisingly, SR141716A itself modulated cytokine responses in a manner identical with that of WIN 55212-2 and HU-210 when administered alone to mice. The agonist-like effects of SR141716A, which were more striking in unprimed than in primed mice, suggested that the antagonist also could function as a partial agonist at the CB1 receptor. Our findings indicate a role for the CB1 receptor subtype in cytokine modulation by CB ligands.

Pyruvate formate-lyase-activating enzyme: strictly anaerobic isolation yields active enzyme containing a [3Fe-4S](+) cluster

Pyruvate formate-lyase-activating enzyme (PFL-AE) from Escherichia coli (E. coli) catalyzes the stereospecific abstraction of a hydrogen atom from Gly734 of pyruvate formate-lyase (PFL) in a reaction that is strictly dependent on the cosubstrate S-adenosyl-l-methionine (AdoMet). Although PFL-AE is an iron-dependent enzyme, isolation of the enzyme with its metal center intact has proven difficult due to the oxygen sensitivity and lability of the metal center. We report here the first isolation of PFL-AE under nondenaturing, strictly anaerobic conditions. Iron and sulfide analysis as well as UV-visible, EPR, and resonance Raman data support the presence of a [3Fe-4S](+) cluster in the purified enzyme. The isolated native enzyme, but not apo-enzyme, exhibits a high specific activity (31 U/mg) in the absence of added iron, indicating that the native cluster is necessary and sufficient for enzymatic activity.

Fat and carbohydrate balances during adaptation to a high-fat

BACKGROUND

Dietary fat contents are highly variable. Failure to compensate for the positive fat balance that occurs during the shift to a high-fat, low-carbohydrate diet by increasing energy expenditure or by decreasing food intake may result in the gain of fat mass.

OBJECTIVE

The objective of this study was to investigate the time course of fat oxidation during adaptation to an isoenergetic high-fat, low-carbohydrate diet.

DESIGN

After a 5-d control diet, dietary fat was increased from 37% of energy to 50% of energy for 4 d in 6 healthy, young lean men. Respiratory quotient and substrate macronutrient oxidation and balance were measured in a respiratory chamber. Fasting concentrations of insulin, glucose, and triacylglycerol; maximal oxygen consumption (f1.gif" BORDER="0">O(2)max) during treadmill exercise; and free-living energy expenditure were determined. Body fat was measured by dual-energy X-ray absorptiometry and visceral adipose tissue by computerized tomography.

RESULTS

Compared with the baseline diet, the high-fat, low-carbohydrate diet resulted in positive fat and protein balances and a negative carbohydrate balance. Insulin concentration and the postabsorptive respiratory quotient were positively correlated with the fat balance during the high-fat, low-carbohydrate diet, whereas f1.gif" BORDER="0">O(2)max during treadmill exercise was negatively related to fat balance. With use of stepwise regression, f1.gif" BORDER="0">O(2)max was the best predictor of fat balance. There was a negative correlation between fat balance and carbohydrate balance (r(2) = 0.88).

CONCLUSION

Both baseline insulin concentration and f1.gif" BORDER="0">O(2)max during treadmill exercise predict fat balance during the shift to a high-fat diet under isoenergetic conditions.

The clinical utility of the MMPI-2 Antisocial Practices Content Scale

This study explored the ability of the MMPI-2 Antisocial Practices Content Scale (ASP) to correctly classify DSM-IV Antisocial Personality Disorder (APD). ASP scores and scores on the MMPI-2 Psychopathic Deviate (Pd) scale were compared in an APD group (n = 10), a Borderline Personality Disorder group (n = 16), a Narcissistic Personality Disorder group (n = 9), an Other Personality Disorder group (representing personality disorders from Clusters A and C; n = 14), and a nonclinical population (NC; n = 67). The ASP exhibited an ability to differentiate APD from other personality disorders and was significantly correlated to DSM-IV diagnostic criteria for APD while the Pd was not. Diagnostic efficiency statistics (sensitivity, specificity, positive predictive power, negative predictive power, overall correct classification rate, and kappa) were calculated under four different conditions in a clinically relevant manner (Kessel & Zimmerman, 1993. Psychological Assessment, 53, 395-399). The results of this study illustrate the usefulness of the ASP as a tool for the assessment of antisocial attitudes, beliefs, and behaviors in individuals suspected of having APD. This information may be valuable to clinicians who are planning treatment or assessing treatment outcome for clients with APD.

Acute asthma in the pediatric emergency department

The management of children with acute asthma remains a difficult and challenging process. Although newer asthma medications are being developed, they are unlikely to have a large impact on the management of children with acute asthma. The leukotriene inhibitors are new anti-inflammatory agents for asthma and are beneficial for the treatment of patients with chronic asthma but have no therapeutic effect during the acute phase of an exacerbation. Older treatments, including the use of magnesium and heliox, have been revisited. Although some children with severe asthma may respond, these do not provide relief for most children with acute exacerbation. The new challenge for asthma care is finding ways to link children with their primary care providers so that regular asthma care can be established. The NHLBI recommends that children with asthma have regular visits with their primary care providers (e.g., four times a year). Regular care results in better adherence to medical and preventive management plans and improves the relationship between patients and physicians. Instituting an asthma action plan, which instructs families on when and how to begin therapy for an acute exacerbation, may prevent progression to a more severe condition.

Diagnosis and management of BK polyomavirus interstitial nephritis in renal transplant recipients

BACKGROUND

Interstitial nephritis caused by BK polyomavirus is a recognized complication of renal transplantation. A study of renal transplant recipients at Duke University Medical Center was undertaken to evaluate diagnostic modalities and assess clinical outcomes in transplant polyomavirus infections.

METHODS

Polyomavirus nephritis was identified in 6 of 240 patients who received renal transplants between January 1996 and June 1998 and an additional patient who underwent transplantation in 1995. The clinical records of these seven patients were reviewed, as were all renal biopsy and nephrectomy specimens. Electron microscopy (EM) was performed on negatively stained urine samples from 6 patients with polyomavirus infection and 23 patients with other diagnoses.

RESULTS

Patients with polyomavirus infection shared several clinical features, including ureteral obstruction (5/7 patients), lymphocele (3/7), bacterial urinary tract infection (3/7), hematuria (3/7), cytomegalovirus infection (3/7), and immunosuppression with mycophenolate mofetil (6/7). All patients experienced elevations in serum creatinine, which stabilized or decreased in four patients with altered or decreased immunosuppression. The diagnosis of polyomavirus infection was established by renal biopsy and EM of urine in five patients, by biopsy alone in one, and by EM alone in one. Sequential examinations of urine by EM were used to monitor the course of infection in six patients.

CONCLUSIONS

Interstitial nephritis due to BK polyomavirus occurred in 2.5% of patients receiving renal transplants at our center since 1996. Polyomavirus infection can cause transplant dysfunction and graft loss, but progression of the infection can frequently be abrogated with alterations in immunosuppressive therapy. Both renal biopsy and EM of urine samples are useful in the diagnosis and monitoring of polyomavirus infections.

Pharmaceutical cost savings of treating obesity with weight loss medications

OBJECTIVE

To evaluate, in compliant patients, the pharmaceutical costs of treating obesity with fenfluramine/mazindol, fenfluramine/phentermine, caffeine/ephedrine, or mazindol relative to the pharmaceutical costs of treating obesity-related comorbid conditions and reducing cardiovascular risk.

METHODS AND PROCEDURES

Subjects were between 18 and 60 years of age with a BMI of >30 kg/m2. Pharmaceutical costs were evaluated in 73 of 220 subjects taking medications for diabetes, hyperlipidemia, or hypertension before and after treatment using fenfluramine with mazindol or phentermine. The pharmaceutical cost of weight loss, cardiac risk reduction, and low-density lipoprotein (LDL) cholesterol reduction was calculated for fenfluramine with mazindol or phentermine, caffeine with ephedrine, or mazindol alone, and compared to approved lipid-lowering medications.

RESULTS

Losses of 6% to 10% of initial body weight reduced pharmacy costs $122.64/month for insulin treated diabetes, $42.92/month for sulfonylurea-treated diabetes, $61.07/month for hyperlipidemia treated with medication, and $0.20/month for hypertension treated with medication. Blood pressure and laboratory evidence of insulin resistance improved in all medication groups. Caffeine/ephedrine was most cost-effective of the three treatments in reducing weight, cardiac risk, and LDL cholesterol.

DISCUSSION

Obesity medications produced a substantial weight loss in compliant patients and resulted in a net pharmaceutical cost savings compared to treating obesity related comorbid conditions.

Plasma myostatin-immunoreactive protein is increased after prolonged bed rest with low-dose T3 administration

It has been hypothesized that myostatin, a newly identified member of the transforming growth factor-beta (TGF-beta) family of proteins, acts as a negative regulator of skeletal muscle growth. Because bed rest induced muscle atrophy results from a decreased rate of muscle protein synthesis, we hypothesized that circulating levels of myostatin would be increased following prolonged bed rest. Twelve men (age, 35.8 +/- 4.6 yr; height, 175.7 +/- 2.3 cm; weight, 74.8 +/- 3.5 kg; mean +/- SE) were confined to bed for 25 days at 6 degrees head-down tilt while receiving triiodothyronine (T3; 50 micrograms/day) to accelerate protein loss. Total lean body and appendicular skeletal muscle mass were determined by dual energy x-ray absorptiometry (DEXA) before and after the bed rest period. Plasma myostatin-immunoreactive protein was measured in blood samples obtained after an overnight fast 5 days prior to, and on the 25th day of bed rest. Lean body mass decreased an average 2.2 kg (p < 0.0001). Appendicular skeletal muscle accounted for a majority of the lean body mass loss. On day 25 of bed rest, plasma myostatin-immunoreactive protein was 12% higher (p = 0.01) than measured at baseline. These data support the idea that myostatin regulates muscle growth in humans and that it may be a novel target for interventions aiming to reduce space flight induced muscle atrophy.

Low-dose T(3) improves the bed rest model of simulated weightlessness in men and women

This study tested the hypothesis that low-dose 3,5, 3'-triiodothyronine (T(3)) administration during prolonged bed rest improves the ground-based model of spaceflight. Nine men (36.4 +/- 1. 3 yr) and five women (34.2 +/- 2.1 yr) were studied. After a 5-day inpatient baseline period, subjects were placed at total bed rest with 6 degrees head-down tilt for 28 days followed by 5-day recovery. Fifty micrograms per day of T(3) (n = 8) or placebo (n = 6) were given during bed rest. Serum T(3) concentrations increased twofold, whereas thyroid-stimulating hormone was suppressed in treated subjects. T(3)-treated subjects showed significantly greater negative nitrogen balance and lost more weight (P = 0.02) and lean mass (P < 0.0001) than placebo subjects. Protein breakdown (whole body [(13)C]leucine kinetics) increased 31% in the T(3) group but only 8% in the placebo group. T(3)-treated women experienced greater changes in leucine turnover than men, despite equivalent weight loss. Insulin sensitivity fell by 50% during bed rest in all subjects (P = 0.005), but growth hormone release and insulin release were largely unaffected. In conclusion, addition of low-dose T(3) to the bed rest model of muscle unloading improves the ground-based simulation of spaceflight and unmasks several important gender differences.

Factors associated with utilization of care for oral lesions in HIV disease

OBJECTIVES

The purpose of this study was to examine factors associated with utilization of care for oral lesions in people with HIV disease.

STUDY DESIGN

The data were derived from 1424 adults who participated in a series of up to 4 interviews as part of the AIDS Cost and Service Utilization Survey. Treatment for thrush, oral sores, and other conditions was evaluated through use of logistic regression, with generalized estimating equations being applied.

RESULTS

In all, 9.1% of those in the study sample reported being treated. After adjusting for CD4 cell count and other variables, regression analyses indicated that blacks (odds ratio [OR], 0.54; 95% confidence interval [CI], 0.32-0.91) and Hispanics (OR, 0.59; 95% CI, 0.36-0.98) had significantly lower odds of reporting being treated. Respondents with more than a high school education (OR, 1.64; 95% CI, 1.08-2.51), clinical trial participants (OR, 1.92; 95% CI, 1.27-2.90), and those receiving counseling (OR, 2.22; 95% CI, 1.60-3.09) were more likely to report being treated.

CONCLUSIONS

Utilization of care for oral lesions is very low. Educational and racial differences exist among those respondents who received care for HIV-associated oral lesions.

State implementation of the AIDS drug assistance programs

Acquired immunodeficiency syndrome (AIDS) drug assistance programs (ADAPs) provide access to medications for people who lack other health coverage. In this article, the authors present the results of a 1997 survey identifying how 48 States implemented ADAPs, focusing on the number of beneficiaries, medical and financial eligibility criteria, the administration of waiting lists, and the coverage of drugs including protease inhibitors. Increased funding for ADAPs is necessary to maintain this important part of the public sector safety net for human immunodeficiency virus (HIV) care.

Access and use of medications in HIV disease

OBJECTIVE

To examine if measures of access to medical care are associated with outpatient use of antiretroviral and Pneumocystis carinii pneumonia (PCP) medications among a cohort of individuals with HIV disease.

DATA SOURCES

Adults who participated in a series of up to six interviews as part of the AIDS Costs and Services Utilization Survey (ACSUS). ACSUS, a panel survey of persons with HIV disease, was undertaken from 1991 through 1992.

STUDY DESIGN

The Andersen Behavioral Model of Health Services Use provided the conceptual framework for the study. Logistic regression analyses with generalized estimating equations were conducted to determine the effects of predisposing, enabling, and need-for-care factors on the odds of antiretroviral or PCP medication use. The analytic sample consisted of 1,586 respondents whose 7,652 interviews provided the data.

PRINCIPAL FINDINGS

The multivariate analysis showed that being female (OR = 0.76; 95% C.I. = 0.60-0.95), ages 15 to 24 years (OR = 0.64; 95% C.I. = 0.44-0.92), and having a hospitalization (OR = 0.73; 95% C.I. = 0.63-0.84) were associated with lower odds of using antiretrovirals. African American race (OR = 1.30; 95% C.I. = 1.04-1.62), having both public and private insurance (OR = 2.11; 95% C.I. = 1.47-3.03), attending counseling (OR = 1.17; 95% C.I. = 1.02-1.34), having a usual source of care (OR = 1.70; 95% C.I. = 1.38-2.11), and clinical trials participation (OR = 1.52; 95% C.I. = 1.23-1.87) were associated with a higher odds of use. Similar results were obtained for analyses of PCP medication use.

CONCLUSIONS

Sociodemographic differences exist in access and use of prescription drugs within the ACSUS cohort. The results suggest that women and those ages 15 to 24 years have poor access to some medications that improve survival in HIV disease.

Depth of vaporization and the effect of pulse stacking with a high-energy, pulsed carbon dioxide laser

BACKGROUND

Laser resurfacing of photodamaged skin has become popular, but questions regarding its safety with regard to the risks of scarring have arisen.

OBJECTIVE

This study was designed to investigate the depth of vaporization and residual thermal necrosis of single-pulse vaporization and multiple passes versus pulse-stacking and multiple passes. The potential significance of operator technique and laser parameters is considered.

METHODS

Skin samples from surgical excisions were treated by means of a Coherent Ultrapulse carbon dioxide laser at 250 mJ per pulse and 500 mJ per pulse with a 3 mm collimated beam and a repetition rate of 10 Hz. A total of 70 treatment areas were performed. Blinded analysis of the histologic effects of single-pulse, double-pulse, and triple-pulse vaporization after 1 through 10 passes was undertaken.

RESULTS

A plateau of vaporization was observed after 3 passes at both 250 and 500 mJ whether single-, double-, or triple-pulse vaporization was used. This plateau occurs at approximately 100 to 250 microm from the skin surface. Thermal necrosis is well controlled only with single-pulse vaporization. There is a direct linear increase in the depth of thermal necrosis both with the number of pulses stacked and the number of passes.

CONCLUSION

Pulsed carbon dioxide laser resurfacing is a safe and self-limited procedure if a pulse width of less than 1 msec is used with single-pulse vaporization and fluences of 3.5 J/cm2 and 7.0 J/cm2. There appears to be little justification for performing more than 3 or 4 passes. Pulse stacking may significantly increase residual thermal necrosis, thereby increasing the risk of scarring. Operator technique may be significant in avoidance of this occurrence.

Visceral adipose tissue: a critical review of intervention strategies

OBJECTIVE

To review the published literature regarding the effect of caloric restriction, pharmacologic intervention, and exercise to promote the loss of visceral adipose tissue (VAT) DESIGN: A review was conducted of published studies which measured VAT using computed tomography or magnetic resonance imaging before and after caloric restriction, pharmacologic therapy, or exercise.

STUDIES REVIEWED

23 separate studies were reviewed. Men represented 38% and women 63% of the 599 volunteers. There were 17 black volunteers and 30 patients with NIDDM included in these studies.

MEASUREMENTS

Data regarding the baseline and change in VAT, body fat, and body weight were collected.

RESULTS

Most interventions demonstrated a preferential loss of VAT regardless of the intervention applied. When expressed as percent change in VAT/percent change in body fat, a ratio can be calculated which we call the Selectivity Index (SI). When this index is applied to the literature reviewed, two observations can be made. First, the Selectivity Index is higher when baseline body fat is higher. Second, there is a direct relationship between the Selectivity Index and the baseline visceral fat ratio. These two observations suggest that individuals with greater visceral fat mass, either through an increase in the body weight or the propensity to store fat in the visceral depot, lose more visceral fat when adjusted to the loss of body fat.

CONCLUSION

In conclusion, the Selectivity Index is useful to compare the ability of an intervention to specifically target the loss of AT. This simple index can serve as a benchmark for comparing intervention studies to each other.

Nonprescription and alternative medication use by individuals with HIV disease

OBJECTIVE

To examine the strength of the associations between predisposing, enabling, and need-for-care variables and the self-treatment of HIV disease; and to compare sociodemographic and illness-related factors associated with the use of vitamins, nonprescription medications, herbs, and recreational substances among HIV-infected individuals.

METHODS

Data were derived from 7887 interviews conducted as part of the AIDS Cost and Services Utilization Survey. The conceptual framework was the Andersen Behavioral Model of Health Services Use. Factors associated with nonprescription and alternative medication use were assessed using logistic regression. Generalized estimating equations were applied to adjust variance estimates for within-person correlations of drug use over time.

RESULTS

After adjusting for perceived health status, T cell count, and stage of disease, the results indicated that African-Americans were less likely to use nonprescription drugs (odds ratio [OR] 0.65, 95% CI 0.52 to 0.81), vitamins (OR 0.59, 95% CI 0.48 to 0.73), and herbs (OR 0.41, 95% CI 0.22 to 0.76), compared with non-Hispanic whites. Similarly, Hispanics were less likely to report use of herbs (OR 0.58, 95% CI 0.34 to 0.98) or recreational drugs (OR 0.34, 95% CI 0.15 to 0.76) than were non-Hispanic whites. Oppositely, individuals who had a college education were more likely to use vitamins (OR 1.26, 95% CI 1.05 to 1.50) and herbs (OR 2.47, 95% CI 1.56 to 3.91). Enabling variables such as insurance status and income were generally associated only with use of recreational drugs. Need-for-care variables were generally associated only with use of nonprescription drugs and vitamins.

CONCLUSIONS

Predisposing, enabling, and need-for-care variables from the Andersen Behavioral Model were significantly associated with the use of four categories of drugs to self-treat HIV disease. However, there was not a consistent pattern across the drug categories.