Methadone and immune function

Up-regulation of soluble tumor necrosis factor receptor two in plasma of HIV-seropositive individuals who use opiates

Previously, we reported an increase in soluble tumor necrosis factor-alpha receptor two (sTNF-R2) and soluble CD14 (sCD14) in the plasma of HIV-seropositive individuals with neurocognitive dysfunction compared to their cognitively intact counterparts. As intravenous drug use is not only a risk factor for HIV but also an immunomodulator, we sought to examine the effects of drug use on soluble markers of immune activation. These relationships were investigated in 25 patients with late stage HIV-1 disease. TNF-alpha, sTNF-R1, sTNFR2, and sCD14 were measured in patient plasma. These values were correlated with drug use and neurocognitive function. sTNF-R2 was significantly up-regulated in those patients who used opiates compared to those who did not. There was no difference in TNF-alpha, sTNF-R1, or sCD14 between the groups. Further, there was no connection between opiate use and neurocognitive dysfunction.

Improving access to primary health care for chronic drug users: an innovative systemic intervention for providers

An intervention was designed to improve access to primary care for chronic drug users (CDUs) by enhancing health care providers' knowledge and skills. Using a case study method, three study sites were systematically selected for intervention implementation: a primary care clinic (PC), an emergency department (ED), and a drug treatment (DT) facility. Participants completed pre- and postintervention tests of knowledge, skills, and intentions to practice. Compared with pretest scores, participants had significantly higher posttest scores concerning knowledge of CDUs' health care needs. Postintervention evaluations indicated intentions to practice skills learned in the intervention. As hypothesized, the PC and ED subsequently instituted formal screening mechanisms to identify CDUs. This intervention revealed potential to build bridges between health care providers and CDUs. By overcoming provider resistance, primary care access can be realized for this and other disadvantaged populations.

Hepatitis C Virus and Human Immunodeficiency Virus-1 Co-Infection in Former Heroin Addicts in Methadone Maintenance Treatment

OBJECTIVES

To investigate hepatitis C (HCV) and human immunodeficiency virus (HIV-1) prevalence in former opiate or heroin addicts currently in methadone maintenance treatment (MMT).

METHODS

Retrospective chart review for patients (n = 342) currently attending two MMT clinics affiliated with New York Presbyterian Hospital (Adolescent Development Program, ADP: n = 106, median age 30 years; Adult Clinic, AC: n = 236, median age 45 years), as of May 2000.

RESULTS

Overall seroprevalence of those tested was 67% for HCV (ADP, 44%; AC, 80%), and 29% for HIV-1 (ADP, 13%, AC, 39%). Co-infection was present in 26% of patients (ADP, 13%; AC, 35%). Prevalence of HCV reached 92% in the 45-49 year old group (n = 53). The greatest HIV-1 prevalence (45%) was in the 35-39 year old group (n = 33). There was a linear relationship between infection seroprevalence and age at admission into MMT.

CONCLUSIONS

The high prevalence of HCV and HIV-1 infections in MMT patients varies both by current age and by age at admission to MMT. This population needs risk reduction education and treatment for HCV and HIV- 1.