Exploring the Clinical Variables among Drug-Dependent HIV-Positive Patients: Implications for Treatment Strategies

This study explored the profile of HIV positive patients seeking treatment at a tertiary care addiction treatment facility. A retrospective study was done to collet detailed information on clinical characteristics: drug use (type, age of initiation, duration), general medical condition and past treatment history. The study included 138 patients with mean (SD) age 30.2 (8.3) years. Opioid dependence with injecting drug use (IDU) was diagnosed in 97% of the patients. The median age of injecting onset was 24.5 years (IQR 20-31 years). The most frequently injected substances were pheniramine (60.1%) and buprenorphine (59.4%). Past treatment seeking was reported by 57% patients and interestingly they were less likely to present any medical condition (2 =69.611, p < 0.001). Variability in the age of onset of drug use indicates the need for broad based approach to prevent IDU and motivation to seek treatment may lead to better health conditions.

Physical and Mental Health Status of Women whose Spouses Inject Drugs – A Cross-Sectional, Multisite Study

Substance use disorder impacts the lives of significant others, more especially the wives of individuals using substances. However, the physical and mental health issues among wives of people who inject drugs(PWID) are less studied. The current cross?sectional, multisite study assessed the physical and mental health of wives of 433 PWID across six sites in Delhi. The mean age of the participants was 32.7 years (standard deviation: 9.7). More than 50% of the participants reported menstrual problems, most commonly dysmenorrhea. Around 55.9% had adverse pregnancy outcomes(abortion, miscarriage, or stillbirth). Around one out of four participants reported at least one specific sexually transmitted infection symptom. Around 11% were diagnosed with tuberculosis and 35% with a major medical illness in their lifetime. More than 90% of the participants had depressive and anxiety symptoms. The study showed that there is a huge burden of physical and mental health issues among the wives of PWID.

Prevalence and predictors of self-reported risk behaviors among male injecting drug users

Background: Unsafe injecting drug use is a documented risk factor for the transmission of human immunodeficiency virus infection. Harm reduction strategy aims at reducing this deleterious consequence. Objectives: To study the prevalence and predictors of injecting as well as sexual risk behavior among male injecting drug users (IDUs). Methods: A cross-sectional study was conducted among 250 male IDUs from January 2017 to March 2018. Risk behavioral data were collected after obtaining informed consent of the study participants. This included information on sharing, reusing needles/injections, and sexual behavior. Descriptive statistics and logistic regression model was run using the Epi Info software version 7.2 for Windows. Results: In the past one month, 25.3% had shared needles/syringes by either borrowing or lending or both. Inconsistent condom use during sexual intercourse with a regular, casual, and paid sex partner was practiced by 64.7% (77/119), 65.8% (48/73), and 45.0% (18/40), respectively. The binary logistic regression analysis revealed that unsafe injecting drug behavior was higher among daily users: (OR = 3.0 [1.3–6.6]) and comparatively lower among those who preferred to avail needles/syringes from Needle Syringe Exchange Program (OR = 0.4 [0.2–0.9]); as compared to their counterparts. Conclusions: The findings suggest that IDUs in the study area are engaging in risk behaviors. Behavior change communication and harm reduction strategy should be strengthened.

Hepatitis C virus (HCV) infection & risk factors for HCV positivity in injecting & non-injecting drug users attending a de-addiction centre in northern India.

Background & objectives: Injecting drug use is a major route of hepatitis C virus (HCV) infection in India, but there may be other risk factors also. this study was carried out to determine the seroprevalence of anti-HCV antibody in injecting drug users (IDUs) vs. non-IDUs (NIDUs), and to study the risk estimates for HCV seropositivity in the total sample of substance users with regard to various demographic, clinical, behavioural and personality factors. Methods: the IDUs (n = 201) and NIDUs (n = 219) were assessed for demographic, clinical and behavioural information, and were rated on instruments for severity of dependence, risk behaviour and personality profiles. Anti-HCV antibody was tested by ELISA and confirmed by recombinant immunoblot assay (RIBA) test. Results: Almost one-third of the IDUs (64 of 201; 31.8%) were positive for anti-HCV antibody, as opposed to only seven (3.2%) of the NIDUs. The four risk factors strongly associated with HCV positivity in multivariate analysis were sharing syringe [Exp(B) 75.04; 95%CI 18.28-307.96; P<0.001], reuse of injection accessories (16.39; 3.51-76.92; P<0.001), blood transfusion (5.88; 1.63-21.23; P=0.007) and IDU status (3.60; 1.26-10.31; P=0.017). Other variables less strongly but significantly associated with HCV positivity were multiple sex partners, opioid dependence, risk behaviour scores, impulsivity, and lower age of onset of drug use. Interpretation & conclusions: Our study showed a high seroprevalence of anti-HCV antibody in IDUs. In the substance users, HCV positivity was significantly and independently associated with several clinical, behavioural, and personality risk factors.

Treating hepatitis C in HIV/HCV co-infected patients in Malaysia- the outcomes and challenges

Background: Co-infection by human immunodeficiency and hepatitis C viruses (HIV/HCV) is common and results in significant morbidity and mortality despite effective antiretroviral therapies (ART). Method: A retrospective and prospective evaluation of the efficacy and safety of pegylated interferon alfa 2a/2b plus ribavirin (PEG-IFN/RBV) in consecutive HIV/HCV co-infected patients treated in real life clinical practice in Malaysia. Results: Forty-five HIV/HCV co-infected patients with a median age (interquartile range, IQR) of 41 years (37; 47) were assessed for treatment with PEG-IFN/RBV. All except one are of male gender and the most common risk behaviour was injecting drug use. At baseline 75.5% was on ART and the median (IQR) CD4 count was 492 cells/µl (376; 621). The HCV genotypes (GT) were 73 % GT3 and 27% GT1. Liver biopsies in forty patients showed 10% had liver cirrhosis and another 50% had significant liver fibrosis. The treatment completion rate was 79.5% with 15.9% dropped out of treatment due to adverse effects (AE) or default and 4.6% due to lack of early virological response. The AE causing premature discontinuations were neuropsychiatric and haematological. The overall sustained virological response (SVR) was 63.6% with a trend towards higher SVR in GT3 compared with GT1 (71.9% vs. 41.7%; p=0.064). In patients with bridging fibrosis plus occasional nodules or cirrhosis on liver biopsy, the SVR was significantly lower at 20% (p=0.030) compared to those with milder fibrosis. Conclusion: HIV/HCV co-infected patients can be successfully and safely treated with PEG-IFN/RBV achieving high rates of SVR except in cirrhotic patients.

Spatial analysis on the HIV/AIDS infection status among injecting drug users in China, from 2005 to 2011 / 中华流行病学杂志

Objective To analyze the spatial distribution of HIV/AIDS epidemics among injecting drug users (IDUs) in China from 2005 to 2011 and to understand its changing trend.Methods Using data on people living with HIV and AIDS through injecting drug between 2005 and 2011 to analyze the demographic characteristics of injecting drug users.Analysis on spatial correlation (provincial level and country level) and median center of hot spots (country level) were conducted by Arcgis software.Results Sex ratio (male/female) and registered place ratio (province/other provinces) reduced as time went by,with the ratios in 2011 as 6.75 and 7.01 respectively.Tape ratio of the disease between HIV and AIDS showed an upward trend (Z=26.880,P＜0.01).Since 2005,the identified numbers of HIV/AIDS and the spatial correlation and hot spots in provincial level had reduced,the numbers of provincial hot spots were two from 2009 to 2011 (Sichuan and Yunnan provinces) at the national level.However,the spatial correlation and hot spots at the provincial level had an increasing trend.Between 2005 and 2011,the Western Median Centers of hot spots was located in Xinjiang province while the Southwestern Median Center of hot spots tended to move towards the north.Conclusion The demographics changes of HIV/AIDS infection among injecting drug users seemed to be regular from 2005 to 2011.Spatial correlation at the provincial level was reducing.However,the spatial correlation and the numbers of hot spots at the country level increased,with hot spots at the country level tended to move from the border areas towards inland.

An Asian perspective on HIV/AIDS

Almost 5 million Asians are currently living with HIV. Without good prevention efforts, HIV prevalence in the region could double by 2020. AIDS is estimated to be the largest cause of death and morbidity due to disease for Asian adults aged between 15 and 44 years. HIV transmission in Asia is driven by three high risk behaviours, and these are unprotected commercial sex, injecting drug use and unprotected sex between men. Approximately three quarters of the people living with HIV in Asia are men, and in many countries, the men who buy sex are a powerful driving force in Asia’s HIV epidemics. These men and others exhibiting high risk behaviours can transmit HIV to their female sexual partners, who can in turn pass HIV onto their unborn or newly born children through mother to child transmission of HIV. Regionally relevant, effective prevention programmes now provide good evidence for changing the course of HIV epidemics: Thailand and Cambodia have demonstrated that even in the face of a severe epidemic, targeted interventions are successful if implemented both with high coverage and intensity. Some countries in the region have seemingly been protected to date, but risk serious epidemics if prevention services are denied to those who need them. When designing intervention strategies, it is important to consider the social, political and cultural contexts which shape risk behaviours in any particular country, so that appropriate and effective prevention strategies can be implemented. The provision of effective antiretroviral treatment must be seen as a complimentary strategy to other behavioural and risk reduction interventions. Commitment and integrated action by country leaders, health care providers and all sectors of the community are essential so that effective prevention and treatment programmes can become a reality for all Asian countries.