Sexual functioning in HIV+ and HIV- injected drug-using women.

As part of a natural history study of HIV disease in injected drug users, 38 HIV positive (HIV+) asymptomatic or low-symptomatic women and 37 HIV negative (HIV-) women, mostly of minority inner-city background, underwent a comprehensive survey of sexual functioning. At study baseline, the sample as a whole showed a relatively high prevalence of problems in all major phases of the sexual response cycle and in vaginismus and vaginal pain. Statistically significant group differences indicate higher rates of problems in sexual functioning in HIV+ women even at an early stage of disease progression.

The argument against HIV-antibody testing in chemical dependence treatment programs.

As HIV continues to spread among chemically dependent populations, chemical dependence treatment programs are beginning to address the issue of routine HIV-antibody testing. While there are many rationales given for testing, only two are deemed acceptable in chemical dependence treatment programs: to permit medical personnel to institute therapy promptly; and to assist in behavior modification (risk reduction). Early intervention is deemed premature because federal regulations disallow the use of drugs, such as AZT, until T-4 cell counts are lower than 200. In addition, many clients may not stay in treatment long enough to institute therapy and ongoing treatment. Many experimental drug trials exclude drug addicts and women. Chemically dependent individuals have neither the knowledge nor the funds to obtain experimental drugs from other countries. Moreover, current protocols of HIV test-related counseling are insufficient to assist clients in changing their high-risk behaviors. Many chemically dependent clients who receive a positive test result relapse to drug abuse or act out sexually; many who receive a negative test result deny the need to change behaviors to avoid infection. Additionally, test result validity and discrimination are presented as deterrents to testing. In long-term treatment situations, where HIV/AIDS education and counseling are done over time as part of treatment and where support systems are in place, HIV testing can be an aid in behavior change.

Cross-sectional study of immunologic abnormalities in intravenous drug abusers on methadone maintenance in New York City.

One hundred and ninety-nine patients with a history of intravenous drug abuse, and enrolled on the St Luke's-Roosevelt Hospital Center Methadone Program, had baseline evaluations performed from September 1984 to April 1987. The study was designed to examine immunologic parameters associated with HIV seropositivity and those predictive of progression to AIDS-related complex (ARC) and AIDS. Sixty-four patients (32%) had antibodies to HIV by enzyme-linked immunosorbent assay (ELISA), with confirmation by Western blot and none of these patients had ARC or AIDS at the time of initial evaluation. The mean values for white blood-cell count, absolute lymphocyte count, proportion and absolute CD4, and CD4/CD8 ratio were decreased significantly in the HIV-seropositive group compared with the HIV-seronegative group. On the other hand, levels of circulating beta 2-microglobulin, SCD8, SIL-2R, and HIV p24 antigen were significantly elevated in the HIV-seropositive group compared with the HIV-seronegative group.

Tumor necrosis factor and HIV P24 antigen levels in serum of HIV-infected populations.

Tumor necrosis factor (TNF) and HIV P24 antigen levels were determined in the serum of intravenous drug abusers (IVDAs), homosexuals, and patients with lymphadenopathy or acquired immune deficiency syndrome (AIDS). The mean TNF level in the serum of normal controls was 12 +/- 5 compared to 112 +/- 25 pg/ml in the serum of HIV-seronegative asymptomatic IVDAs. This increase of TNF may be due to the variety of infections that these people are exposed to persistently. The mean TNF level in the serum of HIV-seropositive asymptomatic IVDAs was 112 +/- 79 pg/ml, 31 +/- 24 pg/ml in lymphadenopathy, and 55 +/- 19 pg/ml in patients with AIDS. The mean P24 level in the serum of patients with AIDS was 50 +/- 13 pg/ml compared to 0 pg/ml in HIV-seronegative subjects, while the other HIV-seropositive groups had relatively low levels. The P24 antigen levels may reflect viral load in these patients. SIL-2R and beta2-microglobulin levels were also elevated in patients with HIV infection . The TNF may play a role in the antiviral activity against HIV virus and in the development of full-blown disease after HIV infection.