Co-morbidity of infectious and addictive diseases in St. Petersburg and the Leningrad Region, Russia.

The Russian health care system is organized around specific diseases, with relatively little focus on integration across specialties to address co-morbidities. This organizational structure presents new challenges in the context of the recent epidemics of injection drug use (IDU) and HIV. This paper uses existing and new data to examine the prevalence of reported new cases of drug dependence (heroin) and HIV over time as well as associations between drug dependence and alcoholism, hepatitis B and C, and tuberculosis in the City of St. Petersburg and the Leningrad region. We found a sharp rise in reported cases of IDU beginning in 1991 and continuing until 2002/2003, followed by a sharp rise in newly reported cases of HIV. These rises were followed by a drop in new cases of HIV and drug addiction in 2002/2003 and a drop in the proportion of HIV-positive individuals with IDU as a risk factor. Infection with hepatitis B and C were common, especially among injection drug users (38 and 85%, respectively), but also in alcoholics (7 and 14%). Tuberculosis was more common in alcoholics (53%) than in persons with alcoholism and drug dependence (10%), or with drug dependence alone (4%). Though these data have many limitations, they clearly demonstrate that drug dependence and/or alcoholism, HIV, hepatitis, and tuberculosis frequently co-occur in St. Petersburg and the Leningrad Region. Prevention and treatment services across medical specialties should be integrated to address the wide range of issues that are associated with these co-morbidities.

[The efficacy of calcium channel blockers in the treatment of affective disorders and pathologic drive for alcohol in patients with alcoholism in the remission period]. / Effektivnost' blokatorov kal'tsievykh kanalov pri lechenii affektivnykh narushenii i patologicheskogo vlecheniia k alkogoliu u bol'nykh alkogolizmom v period remissii.

Forty three patients with chronic alcoholism of stage II with secondary affective disorders (anxiety, subdepression) and actualization of pathological drive for alcohol in remission period were divided into 3 groups: patients were treated with nimodipine (90 mg/day during 10 days), patients were treated with nifedipine (45 mg/day during 10 days) and patients of control group (they received a placebo for 10 days). The study was double blind. The results revealed that both calcium channels antagonists reduced a level of depression measured with the Hamilton scale and Zung test. Ten-day nimodipine (but not nifedipine) course also caused a significant decrease of anxiety evaluated by the Spilberger test. Both medications, being significantly more efficient comparing to placebo, led to desactualization of pathological drive for alcohol in parallel with affective disorders reduction. Because of the absence of the depriming effect of these compounds on CNS as well as of dependence phenomenon, calcium channels antagonists may be used in narcology for stopping secondary affective disorders and actualization of pathological drive for alcohol in remission period.

The onset of HIV infection in the Leningrad region of Russia: a focus on drug and alcohol dependence.

OBJECTIVES: Within 5 years, 5 million Russians may be infected with HIV. Currently, injection drug use is the major risk factor for HIV. As Russia's alcohol consumption per capita is among the highest in the world, alcohol-associated behaviours may be an important contributor to the HIV epidemic. Our objective was to examine the prevalence of HIV infection among drug- and alcohol-dependent patients in a regional narcology hospital and in the general population in Leningrad. METHODS: All patients in the Narcology Hospital, Leningrad Regional Center of Addictions (LRCA), were tested for HIV antibody between 1997 and 2001. We reviewed these clinical records (i.e. serostatus, gender, age, and addiction) and data from the HIV/AIDS Center in the Leningrad Region (1997-2001). RESULTS: From 1997 to 2001, HIV prevalence at the LRCA increased from 0 to 12.7% overall, 33.4% among drug-dependent patients and 1.2% among alcohol-dependent patients. During the same 5-year period (1997-2001), 2826 persons were registered at the HIV/AIDS Center: 6, 6, 51, 780, and 1983 persons in 1997, 1998, 1999, 2000 and 2001, respectively. CONCLUSIONS: HIV infection is exploding in the Leningrad Region, currently in injection drug users (IDUs) but potentially more broadly. The known high per capita alcohol intake in Russia heightens concern regarding the sexual transmission of HIV. Interventions to prevent such a development should include use, and assessment of the effectiveness, of known HIV prevention measures for at-risk and infected individuals.

[Level of autoantibodies to opiate receptors in blood of patients with opiate addiction]. / Issledovanie urovnia autoantitel k opiatnym retseptoram v krovi bol'nykh opiinoi narkomaniei.

The level of autoantibodies to opiate receptors was measured in serum of heroin addicts in withdrawal and in the period of long-term abstinence and in healthy volunteers as well. The level of autoantibodies was assessed with ELISA with synthetic peptide specific for subregions of mu and delta opiate receptors. The scores of the level of autoantibodies higher than 150% of the level noted in healthy volunteers was observed in 56% of heroin addicts. The dependence of autoantibodies level from duration of diseases was shown. Elevated level of opiate receptors autoantibodies were detected in the sera of 71% patients with opiate addiction who had been using heroin more then one year. High levels of opiate receptors autoantibodies were observed more frequently in patients with opiate withdrawal syndrome then in patients with long-term remission. Elevated level autoantibodies to opiate receptors were determined in the blood of 38% opiate abusers with remission for 3-8 months. The level of autoantibodies to opiate receptors may be used for diagnostics of heroin dependence and control of treatment efficiency.

[Ethanol inhibits platelet monoamine oxidase type B activity in patients with alcoholism]. / Ingibiruiushchee deistvie étanola na aktivnost' monoaminoksidazy tipaB trombitsitov u bol'nykh alkogolizmom.

The influence of 400 mM ethanol on the activity of monoamine oxidase type B (MAO-B) of blood platelets has been studied in vitro in 30 alcoholic patients and 30 healthy volunteers. Benzylamine was used as a substrate for MAO-B. MAO-B inhibition by ethanol was higher in alcoholics compared to healthy volunteers. The higher vulnerability of MAO-B of alcoholics inhibiting action to of ethanol may be one of the mechanisms underlying some symptoms of alcoholism.

[The use of baclofen for treating affective disorders in alcoholism]. / Primenenie baklofena dlia lecheniia affektivnykh rasstroistv pri alkogolizme.

90 patients with alcoholism stage II suffering from secondary affective disorders (anxiety, depression) were divided into 4 groups: treated with GABA-B-receptor ligand baclofen (group 1), with sibazon (group 2), amitriptylin (group 3), placebo (group 4). As shown by clinical, experimental psychological and electrophysiological examinations, baclofen is not inferior in efficacy to sibazon and amitriptylin, but is free of side effects and complications typical for the above drugs (central deprivation, addiction, etc.). MAO activity was unaffected in all the patients, so were dopamine, serotonin and GABA blood concentrations after the treatment. This does not allow to relate the peripheral metabolism of GABA and monoamines to emergence of secondary affective disorders in alcoholism. The authors think promising to seek for drugs effective against affective disorders among ligands of GABA-B receptors.

[Study of gamma-aminobutyric acid (GABA) concentration in blood plasma of alcoholism patients]. / Issledovanie kontsentratsii gamma-aminomaslianoi kisloty (GAMK) v plazme bol'nykh alkogolizmom.

Concentration of gamma-aminobutyric acid (GABA) was estimated in the plasma of 104 patients with alcoholism during 2 month treatment course in addiction hospital and in 29 healthy volunteers. Highly distinct differences in content of GABA were detected in the plasma of the volunteers and patients with alcoholism, which remained within 60 days of alcohol withdrawal.

The administration of transcranial electric treatment for affective disturbances therapy in alcoholic patients.

In a double blind placebo-controlled investigation it was shown that transcranial electric treatment (TET), comprising the combination of a constant current with a pulse current of square impulses of 70-80 Hz is an effective method to correct affective disturbances (anxiety, depression) in alcoholic patients. The medical effects of TET are accompanied by changes in the metabolism of GABA and monoamines, but not of beta-endorphin, and also by a decrease in the latency of alpha-rhythm appearance after closing of the eyes.

[One of the methods of treatment of affective disorders in patients with alcoholism]. / Ob odnom iz metodov lecheniia affektivnykh narushenii u bol'nykh alkogolizmom.

It has been demonstrated by a double blind placebo-controlled study that transcranial electric treatment (TET) by means of combination of direct current and pulse current and pulse current at a frequency of 70-80 Hz is an effective method of correcting affective disorders (anxiety, depressions) in patients suffering from alcoholism. The therapeutic effects of TET are coupled with changes in GABA and monoamine metabolism rather than in beta-endorphin as well as with a decrease of the latent period of the occurrence of alpha-rhythm after eyes closing.