The lack of association of marijuana and other recreational drugs with progression to AIDS in the San Francisco Men's Health Study.

We evaluated the associations of specific recreational drugs and alcohol with laboratory predictors of AIDS at entry into the San Francisco Men's Health Study (SFMHS) in 1984 and with the development of the acquired immunodeficiency syndrome (AIDS) during 6 years of follow-up. Marijuana use was associated with a decreased rate of progression to AIDS in the univariate analysis (RR = 0.7; P = 0.01). Marijuana use was more common among individuals with elevated HIV viral core protein antibody (p24Ab) titer (> 1:16) at baseline (P = 0.03); this finding suggests that marijuana users were healthier at baseline. When the data were adjusted for p24 Ab and other laboratory parameters, no association with progression to AIDS was observed for marijuana, suggesting that the observed univariate result was due to a difference in HIV-related disease at the time of enrollment. No statistically significant associations were observed for nitrites, methylene dioxyamphetamines, ethyl chloride, downers, cocaine, stimulants, narcotics, or psychedelic drugs. These data suggest no substantial association between use of these drugs and the development of AIDS among HIV-infected men.

A prospective study of the association of serum neopterin, beta 2-microglobulin, and hepatitis B surface antigenemia with death in infants and children with HIV-1 disease.

A high percentage of HIV-1-infected infants and children in Romania are coinfected with hepatitis B virus. Little information is available on the impact of concurrent hepatitis B infection on the course of HIV-1 infection. We conducted a prospective cohort study over 1 year in a group of 68 HIV-1-infected infants and children to determine whether hepatitis B surface antigenemia, neopterin, and beta 2-microglobulin (B2M) predicted death. Among the 44 hepatitis B surface antigen-positive (HBsAg+) subjects at enrollment, 13 (30%) died during 1 year of follow-up. In comparison, two of 24 (8%) HBsAg-negative subjects died (RR = 7.7; p = 0.05). Higher initial serum concentrations of neopterin and B2M were negatively associated with survival. After stratifying by baseline clinical evidence of HIV-related disease, survival was negatively associated with HBsAg+ status (p = 0.04) in 33 children in stage P-2, adjusting for age, serum neopterin, and serum B2M levels. The results of this study suggest that serum neopterin is a marker for severity of clinical illness and that HBsAg+ status increases the mortality rate among children with clinical evidence of HIV infection.

Association of immune activation with intravenous heroin use and methadone treatment in HIV-1 seropositive and seronegative subjects.

This study evaluated the effect of continued heroin use during methadone treatment on serum neopterin levels in 40 human immunodeficiency virus (HIV) type 1 seropositive (HIV+) and 70 seronegative (HIV-) intravenous drug users (IVDUs). Persistent drug use, determined by urinary evidence of opiates, was more common in HIV+ than in HIV- IVDUs (p = 0.01). Serum neopterin concentration, an indicator of increased probability of progression to AIDS, was elevated in HIV+ IVDUs, p < 0.0001 (mean 16.0 nmol/L) compared to that of HIV- IVDUs (mean 10.0 nmol/L) and in persistent IV drug users compared with abstainers, p < 0.0001. The effect of drug use and HIV status on serum neopterin was not explained by differences in methadone treatment, age, sex, or total years of i.v. drug use. Neopterin decreased in 25 IVDUs, regardless of HIV serostatus, treated with methadone for an average of 1.5 years.