Human immunodeficiency virus infection and nutritional status in female drug addicts undergoing detoxification: anthropometric and immunologic assessments

Effect of immunonutritional status, healthcare factors, and lifestyle on acute respiratory infections among under-5 children in Bangladesh

INTRODUCTION

Acute respiratory infection is a major cause of death for under-5 children in Bangladesh. We aimed to analyze the effect of immunonutritional status, healthcare factors, and lifestyle on the incidence of acute respiratory infection among under-5 children taking individual-level and contextual-level risk factors into consideration.

METHODS

This study recruited 200 children suffering from acute respiratory infection and 100 healthy controls matched by age, sex, and sociodemographic profile. Serum antioxidant vitamin A (retinol), vitamin C (ascorbic acid), and vitamin E (α-tocopherol) were assessed along with the impact of vaccination, socioeconomic factors, and Z-score on the incidence of acute respiratory infection.

RESULTS

Serum antioxidant vitamins were significantly lower in the acute respiratory infection children compared to the non-acute respiratory infection group. Vitamin A was found to be significantly high in acute respiratory infection children who were breastfed for more than 1 year. Vitamin E levels were found to be significantly higher in the acute respiratory infection children who were immunized. Compared to the children living in tin-shed house or huts, serum vitamin E level increased in those acute respiratory infection children who resided in apartments. Vitamin A level was significantly high in those acute respiratory infection children whose height-for-age was -2 SD and above (Z-score), and vitamin C levels were also significantly high in those acute respiratory infection children whose weight-for-height was -2 SD and below (Z-score).

CONCLUSION

Deficiencies of antioxidant vitamins along with healthcare and lifestyle factors have a significant influence on the incidence of acute respiratory infection among under-5 children in Bangladesh.

High rates of serum selenium deficiency among HIV- and HCV-infected and uninfected drug users in Buenos Aires, Argentina

OBJECTIVE

To describe the prevalence of low serum Se and determine whether HIV, hepatitis C virus (HCV) and/or the types of drugs used are associated with serum Se in a cohort of infected and uninfected drug users.

DESIGN

Independent correlates of low serum Se levels based on data collected from food recalls, physical examinations and clinical questionnaires were identified using multivariate regression analysis.

SETTING

Buenos Aires, Argentina

SUBJECTS

A total of 205 (twenty-five female and 180 male) former and current drug users.

RESULTS

Drug users had an average serum Se level of 69·8 (sd 32·8) μg/d, [corrected] and 82 % were considered deficient (<85 μg/l). [corrected] Multivariate analyses found that HIV- and/or HCV-infected individuals had lower mean Se compared with healthy, uninfected drug users (HIV/HCV co-infection: -25·3 μg/l (se 7·6), P = 0·001; HIV alone: -28·9 μg/l (se 6·9), P < 0·001; HCV alone: -19·4 μg/l (se 7·1), P = 0·006). Current and previous drug use was associated with higher serum Se. Cigarette smoking and heavy alcohol consumption were not found to be associated with Se status.

CONCLUSIONS

Low serum Se levels are highly prevalent among drug users in Buenos Aires, Argentina. Se supplementation and/or dietary interventions may be warranted in drug users who are at high risk for HIV and/or HCV infection.

Investigation of serum trace element, malondialdehyde and immune status in drug abuser patients undergoing detoxification

Drug abuser patients (n=104), age ranging from 19 to 42 years, were randomly recruited to investigate the serum levels of trace elements (Cu, Zn, Fe, and Mg), malondialdehyde (MDA), and immunoglobulin (IgG, IgA, and IgM) before and after clinical intervention. Control group also included 104 healthy individuals. Blood samples were analyzed for determining trace elements, MDA, and immunoglobulin using atomic absorption spectroscopy, Ultraviolet-Visible (UV-VIS) spectroscopy, and turbidimetry method, respectively. For serum level of Zn and Fe, the differences between the groups (before intervention, after intervention, and control) were not significant (p>0.05). However, significant differences were found in serum copper levels between control group, drug abuser patients, and before and after intervention (p<0.05). The concentration of Mg was found to be significantly higher (p=0.007) in drug abuser patients than the controls, and after intervention, the level was restored to control value. A displacement of elemental homeostasis was observed in drug abuser patients compared to control, and it was improved after intervention. An increase in serum concentration of MDA was found in drug abuser patients compared to control subjects (p>0.05) but was not statistically significant. After intervention, the concentration was restored to control value (p>0.05). The serum concentrations of IgA and IgM were found to be significantly higher (p<0.05) in drug abuser patients before intervention than the controls, and the level tended to be restored to control level after clinical intervention. Serum IgG level was found to be lower in drug abuser patients compared to controls and further declined significantly (p<0.05) after intervention. These findings may suggest a possible imbalance in the levels of micronutrients, antioxidants, and immunoglobulin in drug abuser patients, which tend to be restored to control values after detoxification.

Serum antioxidant micromineral (Cu, Zn, Fe) status of drug dependent subjects: Influence of illicit drugs and lifestyle

Background

Use of illicit drugs induces multiple nutrient deficiencies. Drug habit, sexual practice and socioeconomic factors influence the nutrient profile of drug dependent subjects. The literature on this issue is still insufficient. This study has tested the hypothesis that illicit drug use and lifestyle impair mineral status. To test this hypothesis, 253 men multiple drug users of age 18–45 years were recruited to investigate their serum copper, zinc and iron levels. Influence of illicit drugs and their lifestyle on the mineral levels was also examined. The study subjects were drug dependent who had shared needles and had sexual activity with multiple partners. Serum concentrations of the minerals were estimated by atomic absorption flame spectrometry.

Results

Results showed a significant increase in serum copper and zinc concentrations, and decrease in iron level in drug dependent subjects. The increase of copper level was found to be much higher than that of zinc. Period of drug abuse had made a significant positive influence on the copper and iron levels, but it was apparently reversed for zinc concentration. Multiple sexual partnerships had significant influence on zinc status. There also were significant relationships observed between body mass index (BMI) as well as certain socioeconomic factors, and mineral status of drug dependent subjects and non-drug dependent controls. A series of multiple linear regression analysis predicted mineral values for education, age and BMI. The group (drug dependent subject = 1, non-drug dependent control = 2) had a significant influence on these parameters. However, after controlling these factors, it was shown that illicit drug use significantly contributed to influence the serum mineral levels.

Conclusion

Illicit drug use impairs serum mineral value causing an increase in copper and zinc and a decrease in iron. Lifestyle and nutritional status of drug dependent subjects influence serum mineral concentrations.

Dietary intake and body mass index in HIV-positive and HIV-negative drug abusers of Hispanic ethnicity

Objective:

Malnutrition in drug abusers has been attributed to poor diet. However, previous studies are conflicting. Many studies have not considered possible concurrent HIV disease. The purpose of this study was to determine the relationship between drug abuse and dietary intake in Hispanic Americans with and without HIV infection.

Design:

Dietary intake was measured using 3-day food records and 24-hour dietary recalls in three groups: HIV-positive drug abusers, HIV-negative drug abusers and HIV-positive persons who do not use drugs (‘non-drug abusers’).

Setting:

The baseline data from a prospective cohort study of the role of drug abuse in HIV/AIDS weight loss and malnutrition conducted in Boston, Massachusetts, USA.

Subjects:

The first 284 participants to enrol in the study.

Results:

HIV-positive drug abusers had a body mass index (BMI) that was significantly lower than that of HIV-positive non-drug abusers. Reported energy, fat and fibre intakes did not differ between groups. All groups had median reported intakes of vitamin A, vitamin B6, vitamin B12, selenium and zinc that were in excess of the dietary reference values (DRI). Intakes of α-tocopherol were below the DRI, but did not differ from intakes of the general US population. However, increasing levels of drug abuse were associated with lower reported intakes of vitamin B6, vitamin B12, selenium and zinc.

Conclusions:

Overall, this study does not support the notion that dietary intake can explain the lower BMI of HIV-positive drug abusers. Further studies examining non-dietary determinants of nutritional status in drug abusers are warranted.

Serum immunoglobulins and white blood cells status of drug addicts: influence of illicit drugs and sex habit

The aim of this study was to investigate the serum immunoglobulins and white blood cells status of drug addicts and to assess the extent of influence of drug habit and sexual practice on the immune components. The study was conducted among 253 male drug addicts and 100 non-addict controls of aged 18-45 years. An enzyme-linked immunosorbent assay (ELISA) was employed to analyse the serum immunoglobulin concentrations. White blood cells profile was estimated by counting 200 cells. Results showed a significant increase (p<0.03) of serum IgG, IgA and IgM in the drug addicts (6.93+/-1.53 g/l, 2.90+/-1.13 g/l and 1.72+/-0.73 g/l, respectively) compared to those in the cohort controls (6.52+/-1.05 g/l, 2.61+/-0.83 g/l and 1.52+/-0.59 g/l, respectively). A significant (p=0.00) decrease of peripheral lymphocytes (51.8+/-15.2 vs. 71.9+/-11.5) was noted in the drug addicts. Monocytes (8.3+/-4.9), neutrophils (128.2+/-18.9) and eosinophils (11.4+/-5.8) were found to be increased in the drug addicts against those in the controls (5.2+/-2.5, 113.2+/-13.0 and 9.6+/-5.8, respectively). Multiple drug abuse for longer period had resulted in a significant (p<0.05) decrease of serum immunoglobulins and lymphocytes. The longer period of addiction had also made a significant (p<0.05) decrease of eosinophils (p=0.05) and an increase of monocytes and neutrophils. Sex with multiple sexual partners had shown a significant (p<0.01) decrease of serum immunoglobulins and eosinophils.

Nutritional status of drug addicts undergoing detoxification: prevalence of malnutrition and influence of illicit drugs and lifestyle

The aim of the present study was to investigate the nutritional status of drug addicts, the prevalence of malnutrition among them and the influence of their drug habit and lifestyle factors on their nutritional indices. The study was conducted among 253 male drug addicts, who sought detoxification at the Central Drug Addiction Treatment Hospital, Dhaka, during the period of June 1998-July 1999. One hundred age-, height- and socioeconomic-matched non-addicted healthy men were recruited by convenience as cohort controls. Results showed that the drug addicts had significantly (P<0.001) lowered BMI, haemoglobin, and serum total protein and albumin levels. Clinical signs of nutrient deficiency were diagnosed in about 74 % of drug addicts. The BMI, biochemical values and nutrient deficiency signs indicated that more than 60 % of drug addicts were suffering from multiple malnutrition. One-way ANOVA demonstrated a significant (P<0.05) negative correlation between drug habit, sexually transmitted diseases and selected nutritional indices, and a positive correlation between education, income and the nutritional indices. A series of multiple regression analyses revealed that education, income and age showed significantly predicted BMI and biochemical indices, and the group (non-drug addicts or drug addicts) had a significant negative effect on these parameters in favour of controls.

Serum vitamin E, C and A status of the drug addicts undergoing detoxification: influence of drug habit, sexual practice and lifestyle factors

BACKGROUND

The study was carried out on the hypothesis that drug addicts would have reduced vitamin E, C and A status which could be influenced by drug habit, sexual practice and lifestyle factors.

METHOD

Serum concentrations of Vitamin E, C and A of male drug addicts and cohort controls were analysed, and influence of drug habit, sexual practice and lifestyle factors of the addicts on the vitamin status was assessed. The study was conducted among 253 drug addicts who sought detoxification voluntarily during the period of June 1997 to July 1998 at the Central Drug Addiction Treatment Hospital, Dhaka, and 100 cohort control men. Research instruments were questionnaire and blood specimens. HPLC and spectrophotometric methods were used to determine the vitamin levels in sera of drug addicts.

RESULTS

alpha-Tocopherol (12.60+/-3.73 compared with 16.3+/-3.37 micromol/l; t=8.6, P=0.05), ascorbic acid (21.59+/-10.5 compared with 38.3+/-13.62 micromol/l; t=10.93, P=0.003) and retinol (1.15+/-0.39 compared with 1.33+/-0.30 micromol/l; t=5.28, P=0.048) in the drug addicts were significantly low as compared to those in the cohort controls. Use of multiple illicit drugs for a longer period of time did result in reduced levels of these vitamins. A significant reduction in retinol concentration was noted among the multiple drug users (F(2,250)=3.23, P=0.041). Duration of addiction had a significant linear correlation with the level of reduction in retinol (F(2,250)=3.23, P=0.041) and alpha-tocopherol (F(2,250)=3.06, P=0.049). Apart from having a significant negative correlation between number of sexual partners and retinol level (F(3,247)=2.65, P=0.049), sexual practice did not have any influence on the vitamin status of the addicts. Occupation did have a significant effect on the ascorbic acid level (F(4,248)=2.46, P=0.046), but other socioeconomic factors like income, age etc did not influence the vitamin E, C and A levels. Body mass index had a positive linear correlation with the vitamins, but it was significant only with vitamin C (F(2,250)=7.06, P=0.001).

CONCLUSIONS

These results could have important implications for providing an antioxidant therapy to drug addicts and thus rehabilitating them into normal life. Risk of HIV infection and transmission (if any) could be reduced or inhibited.

Obesity and immune function relationships

The immunological processes involved in the collaborative defence of organisms are affected by nutritional status. Thus, a positive chronic imbalance between energy intake and expenditure leads to situations of obesity, which may influence unspecific and specific immune responses mediated by humoral and cell mediated mechanisms. Furthermore, several lines of evidence have supported a link between adipose tissue and immunocompetent cells. This interaction is illustrated in obesity, where excess adiposity and impaired immune function have been described in both humans and genetically obese rodents. However, limited and often controversial information exist comparing immunity in obese and non-obese subjects as well as about the cellular and molecular mechanisms implicated. In general terms, clinical and epidemiological data support the evidence that the incidence and severity of specific types of infectious illnesses are higher in obese persons as compared to lean individuals together with the occurrence of poor antibody responses to antigens in overweight subjects. Leptin might play a key role in linking nutritional status with T-cell function. The complexities and heterogeneity of the host defences concerning the immune response in different nutritional circumstances affecting the energy balance require an integral study of the immunocompetent cells, their subsets and products as well as specific and unspecific inducer/regulator systems. In this context, more research is needed to clarify the clinical implications of the alterations induced by obesity on the immune function.