Exposure to hepatitis B and C and to HTLV-1 and 2 among Israeli drug abusers in Jerusalem.

The incidence of exposure to hepatitis B (HBV) and C (HCV) viruses and to that of HTLV 1 and 2 were investigated in a group of 181 illicit drug users attending a drug rehabilitation centre in Jerusalem. In this predominantly male group, 28% were intravenous drug abusers (IVDAs) and 72% non-IVDAs; 92% of the individuals were of Middle Eastern descent (of which 40% were of a Moroccan descent). Antibodies to hepatitis C virus (anti-HCV) were found in 54% of the IVDAs compared with 4.5% in the non-IVDAs (p < 0.001), indicating the presence of a significant reservoir of HCV among this IVDA group. Evidence for previous hepatitis B (HBV) infection was found in 26% of the IVDAs and 33% of the non-IVDAs (p = NS) with no HbSAg positivity. The similar prevalence of previous HBV infection in both drug abuser groups, which was also observed when the groups were analysed according to their ethnic origin, suggests that a vertical transmission of HBV rather than an exclusive association with intravenous drug abuse may have been the source of exposure to HBV. HTLV-1 rates were 2% among IVDAs and 0% among non-IVDAs (p = NS). No serologic evidence for HTLV-2 was detected in this cohort. The present study supports previous observations in other countries and indicates the exceptionally high prevalence of HCV infection among Israeli i.v. drug abusers. It also suggests that using HBV seropositivity as an indicator for needle exchange among drug abusers may be of limited value in geographic areas where vertical transmission of HBV is common. HCV antibodies might become more suitable markers for this purpose.

The efficacy of naltrexone in preventing reabuse of heroin after detoxification.

The efficacy of Naltrexone in preventing reabuse of heroin among heroin addicts in Israel was studied in a double-blind, controlled design. Naltrexone (or placebo) treatment was given as part of a general treatment plan that continued for 12 weeks. Thirty-two addicts who successfully completed a detoxification program and met research criteria, were included in the study. Fifty milligrams of Naltrexone were taken orally three times a week (25 mg twice a week for the first 2 weeks). The follow-up procedure included an interview, urine tests, and screening for possible adverse effects. In addition, social and psychological parameters were evaluated. Fewer heroin-positive urine tests were found the Naltrexone group than in the placebo group. Throughout the entire study, the number of drug-free patients in the Naltrexone group was higher than in the placebo group. The Naltrexone group showed a significant improvement in most psychological parameters as compared with the placebo group. No differences were found in compliance or ratio of adverse effects between the Naltrexone and placebo groups. The concept "heroin abuse load" based on daily heroin consumption and duration of addiction enabled us to predict which addicts would complete the treatment program. The results suggest that heroin addicts in Israel may benefit from treatment with Naltrexone.

Pattern of drug abuse and prevalence of antibodies to human immunodeficiency virus in heroin addicts in Jerusalem, 1989.

Intravenous drug abuse is a principal factor in the spread of AIDS. In contrast to many countries in the Western world, most of the heroin addicts in Israel do not inject. This study attempts to clarify the link between the pattern of drug abuse and seroprevalence for human immunodeficiency virus (HIV) among volunteers attending a detoxification clinic in Jerusalem. Three hundred heroin abusers were interviewed about their drug habits and sexual preference. In addition, all participants underwent HIV serological testing. The majority of them took heroin by smoking, with only 19% injecting the drug. None of the participants in the study were HIV seropositive. An association is seen between the pattern of illicit drug use in Israel and the low incidence of AIDS in this country.