Syringe HIV seroprevalence and behavioural and demographic characteristics of intravenous drug users in Sydney, Australia, 1987

The contents of needles and syringes returned by intravenous drug users to two Sydney needle and syringe exchange centres were analysed for HIV antibodies by the enzyme-linked immunosorbent assay (ELISA). Reactive and borderline samples were further tested by the Western blot method. Basic demographic and needle sharing data were also collected from the clients of the exchanges. Of a sample of 1544 returned syringes, 48 (3%) were confirmed as containing HIV-infected blood. The proportion of infected syringes at exchange 2 was 6% (33 out of 545), which was significantly greater (P less than 0.05) than the proportion of exchange 1 at 1.5% (15 out of 999). The difference in seroprevalence between the two centres may be related to the behavioural characteristics of the client populations that attended each of the exchanges. The maintenance of a low syringe HIV seroprevalence (1-1.5%) over a 7-month period at one exchange may indicate that the availability of sterile needles and syringes prevented transmission of HIV among the clients of that exchange. HIV antibody testing of the contents of used syringes is a potentially valuable method of monitoring HIV infection among intravenous drug users. In this study, syringe exchange schemes have proved to be suitable venues for investigating the demographic characteristics and risk-taking behaviours of this population.

Classification of overdose/self-poisoning presentations to an accident and emergency department

A simple classification system of overdoses presenting to a hospital emergency department is described. Five major overdose categories were developed (accidental, suicidal behavior, recreational/experimentation, compulsive use, and an indeterminate category), which were divided into 10 subcategories. A prospective survey at an inner-city hospital in Sydney classified 199 consecutive self-poisoning presentations as being due to compulsive drug use in 38% of cases; suicidal gesture as a reaction to stress, 17%; adverse reactions to recreational or experimental use, 15%; suicidal gesture to influence others, 7%; genuine accident or noncompliance with medication, 6%; genuine suicide attempt, 3%; and pseudo-overdose, 3%. The reason for the overdose was uncertain in the remainder of the cases. Additional data are also presented, including the types of drugs involved in each overdose category. Categories of overdose may be useful in psychosocial assessment for follow-up interventions, assist in research, and help reduce negative attitudes toward overdoses.

Antibodies to the human immunodeficiency virus in needles and syringes used by intravenous drug abusers

The sharing of needles and syringes by intravenous drug abusers has been recognized as a critical factor in the transmission of the human immunodeficiency virus (HIV). In an attempt to reduce the sharing of needles and syringes among intravenous drug abusers, a pilot sterile needle-and-syringe exchange programme was established in an inner city neighbourhood in Sydney. The contents of exchanged syringes were screened for antibody to HIV by the enzyme-linked immunosorbent assay (ELISA); reactive and borderline samples were tested further by the Western Blot method. Of a sample of 300 needles-and-syringes that were exchanged, three (1%) needles-and-syringes were confirmed as containing antibody-seropositive blood by both ELISA and Western Blot methods and thus as being potentially infectious. As only 70% of known positive-control syringes were detected in this study, the proportion of potentially infectious needles-and-syringes that was found may have underestimated the proportion of infectious injection equipment that was returned. These findings highlight the importance of the removal of used needles and syringes from circulation in addition to the supply of sterile equipment. This method of monitoring exchanged needles-and-syringes is suggested as a means to evaluate measures that are designed to reduce the transmission of HIV among intravenous drug abusers. The rapid implementation of sterile needle-and-syringe exchange programmes is imperative to stem the spread of HIV infection.

Exposure of intravenous drug users to AIDS retrovirus, Sydney, 1985

A survey of a cohort of 200 intravenous (IV) drug users drawn from five drug referral agencies was conducted in Sydney in 1985 and revealed only one heterosexual male with antibodies to AIDS retrovirus (ARV). Contact tracing of sexual and needle-sharing partners resulted in the referral of a further four out of six at-risk individuals seropositive for ARV. This study indicates that ARV has now reached the IV drug-using population and could be spread further among IV drug users by sexual contact and by needle-sharing. We conclude that exposure to ARV among IV drug users is in its earliest stages in Australia. There is an urgent need to introduce measures such as contact tracing and screening of IV drug users to prevent further spread of ARV in this risk group.

Cryptosporidiosis in the acquired immune deficiency syndrome

Cryptosporidiosis was found in a patient with the acquired immune deficiency syndrome. The microbiological and morphological features of this newly recognized opportunistic infection are distinctive and diagnostic.

The measurement of enzyme activities in endomyocardial biopsies from patients with congestive (dilated) cardiomyopathy and specific heart muscle disease

50 patients with heart muscle disease have been investigated using routine invasive and non-invasive techniques, including endomyocardial biopsy. Enzyme activities in myocardial tissue obtained by biopsy have been measured in dilated cardiomyopathy and heart muscle disease and compared. Significant differences in enzyme activity have been found between dilated cardiomyopathy and alcoholic heart muscle disease when the groups are defined by detailed drinking histories. CPK (p less than 0.002), MDH (p less than 0.001), LDH (p less than 0.001) and alpha HBD (p less than 0.001). The changes in the enzyme levels may be an adaptive response to alcohol although serial study did not show a fall in enzyme activities after 3-6 months abstinence. Preliminary data furthermore indicates an association of the alpha HBD/LDH and LDH/CPK enzyme activity ratios and ejection fraction. This data supports the diagnosis of a specific heart muscle disease in response to alcohol excess.