Heroin Use and HIV Disease Progression: Results from a Pilot Study of a Russian Cohort

Edelman, E. Jennifer; Cheng, Debbie M.; Krupitsky, Evgeny; Bridden, Carly; Quinn, Emily; Walley, Alexander Y.; Lioznov, Dmitry; Blokhina, Elena; Zvartau, Edwin; Samet, Jeffrey H.

doi:10.1007/s10461-014-0948-z

Cited by 9 publications

(12 citation statements)

References 55 publications

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“…alcohol) , the highly beneficial changes with ART may negate more subtle effects of prescribed opioids; whether our findings apply to patients not on ART or on long‐term ART is currently unknown. Secondly, opioid withdrawal may be particularly deleterious to the immune system , including to CD4 cell counts . Our categorization of prescribed opioid exposure duration into three groups, none, short‐term and long‐term, is unlikely to be able to differentiate effects on CD4 cell count that may have related to intermittent use of prescribed opioids where withdrawal episodes may be more common.…”

Section: Discussionmentioning

confidence: 94%

“…illicit opioids and opioid agonist treatment) and their impact on HIV-related outcomes. These studies are inconsistent in their findings; some studies demonstrated no evidence of an association between illicit drug use [68] and HIV disease progression, while others found such evidence [44,69,70]. These studies, however, included nonopioid (e.g.…”

Section: Discussionmentioning

confidence: 97%

“…Similarly, epidemiological data have been difficult to interpret as they often focus on illicit opioid use (i.e. heroin) in the context of addiction [32][33][34][35][36][37][38][39][40][41][42][43][44], with variability in control groups, measures of ART adherence, opioid exposure, and other drug use (i.e. cocaine) [45] known to impact HIV diseaserelated outcomes.…”

Section: Introductionmentioning

confidence: 99%

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The impact of prescribed opioids on CD4 cell count recovery among HIV‐infected patients newly initiating antiretroviral therapy

et al. 2016

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Objectives Certain prescribed opioids have immunosuppressive properties, yet their impact on clinically relevant outcomes, including antiretroviral therapy (ART) response among HIV-infected patients, remains understudied. Methods Using the Veterans Aging Cohort Study data, we conducted a longitudinal analysis of 4,358 HIV-infected patients initiating ART between 2002 and 2010 and then followed them for 24 months. The primary independent variable was prescribed opioid duration, categorized using pharmacy data as none prescribed, short-term (<90 days), and long-term (≥90 days). Outcomes included CD4 cell count over time. Analyses adjusted for demographics, comorbid conditions, ART type and year of initiation, and overall disease severity (ascertained with the VACS index). Sensitivity analyses examined whether effects varied according to baseline CD4 cell count, achievement of viral load suppression, and opioid properties (i.e., dose and known immunosuppressive properties). Results Compared to those with none, patients with short-term prescribed opioids had a similar increase in CD4 cell count (rise per year: 74 vs. 68 cells/mm3, p=0.11), as did those with long-term prescribed opioids (rise per year: 74 vs. 75 cells/mm3, p=0.98). In sensitivity analysis, compared to those with none, short-term prescribed opioid effects were statistically significant among those with baseline CD4 cell count ≥500 cells/mm3 (rise per year: 52 vs. 20 cells/mm3, p=0.04); findings were otherwise unchanged. Conclusions Despite immunosuppressive properties intrinsic to opioids, prescribed opioids appeared to have no effect on CD4 cell counts over 24 months among HIV-infected patients initiating antiretroviral therapy.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

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The impact of prescribed opioids on CD4 cell count recovery among HIV‐infected patients newly initiating antiretroviral therapy

et al. 2016

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“…The interaction of HIV and HCV infections and injection drug use is largely undefined. However, injection drugs such as heroin promotes disease progression in HIV and HCV infected individuals (5, 6) .…”

Section: Introductionmentioning

confidence: 99%

Serum adiponectin in HIV-1 and hepatitis C virus mono- and co-infected Kenyan injection drug users

Ndombi¹,

Budambula²,

Webale³

et al. 2015

Endocrine Connections

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Adiponectin is an important marker of anthropometric profiles of adipose tissue. However, association of adiponectin and adiposity in HIV mono- and co-infected and hepatitis (HCV) injection drug users (IDUs) has not been elucidated. Therefore, the relationship of total adiponectin levels with anthropometric indices of adiposity was examined in HIV mono-infected (anti-retroviral treatment, ART-naive, n=16 and -experienced, n=34); HCV mono-infected, n=36; HIV and HCV co-infected (ART-naive, n=5 and -experienced, n=13); uninfected, n=19 IDUs; and healthy controls, n=16 from coastal Kenya. Anthropometric indices of adiposity were recorded and total circulating adiponectin levels were measured in serum samples using enzyme-linked immunosorbent assay. Adiponectin levels differed significantly amongst the study groups (P<0.0001). Post-hoc analyses revealed decreased levels in HIV mono-infected ART-naive IDUs in comparison to uninfected IDUs (P<0.05) and healthy controls (P<0.05). However, adiponectin levels were elevated in HCV mono-infected IDUs relative to HIV mono-infected ART-naive (P<0.001) and -experienced (P<0.001) as well as HIV and HCV co-infected ART-naive (P<0.05) IDUs. Furthermore, adiponectin correlated with weight (ρ=0.687; P=0.003) and BMI (ρ=0.598; P=0.014) in HIV mono-infected ART-naive IDUs; waist circumference (ρ=−0.626; P<0.0001), hip (ρ=−0.561; P=0.001) circumference, and bust-to-waist ratio (ρ=0.561; P=0.001) in HIV mono-infected ART-experienced IDUs; waist girth (ρ=0.375; P=0.024) in HCV mono-infected IDUs; and waist-to-hip ratio (ρ=−0.872; P=0.048) in HIV and HCV co-infected ART-naive IDUs. Altogether, these results suggest suppression of adiponectin production in treatment-naive HIV mono-infected IDUs and that circulating adiponectin is a useful surrogate marker of altered adiposity in treatment-naive and -experienced HIV and HCV mono- and co-infected IDUs.

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“…While a number of studies have found that psychostimulant abuse accelerates the progression of HIV and related diseases, irrespective of its effects on adherence (Baum et al, 2009; Burbano et al, 2001; Kipp et al, 2011; Lucas et al, 2006; Moore et al, 2004; Webber et al, 1999), other reports contradict this finding. (Cofrancesco et al, 2008; Edelman et al, 2015; Milloy et al, 2016; Thames et al, 2016). …”

Section: Tat and Psychostimulant Abusementioning

confidence: 99%

HIV, Tat and dopamine transmission

Gaskill

Miller

Gamble-George

et al. 2017

Neurobiology of Disease

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Human Immunodeficiency Virus (HIV) is a progressive infection that targets the immune system, affecting more than 37 million people around the world. While combinatorial antiretroviral therapy (cART) has lowered mortality rates and improved quality of life in infected individuals, the prevalence of HIV associated neurocognitive disorders is increasing and HIV associated cognitive decline remains prevalent. Recent research has suggested that HIV accessory proteins may be involved in this decline, and several studies have indicated that the HIV protein transactivator of transcription (Tat) can disrupt normal neuronal and glial function. Specifically, data indicate that Tat may directly impact dopaminergic neurotransmission, by modulating the function of the dopamine transporter and specifically damaging dopamine-rich regions of the CNS. HIV infection of the CNS has long been associated with dopaminergic dysfunction, but the mechanisms remain undefined. The specific effect(s) of Tat on dopaminergic neurotransmission may be, at least partially, a mechanism by which HIV infection directly or indirectly induces dopaminergic dysfunction. Therefore, precisely defining the specific effects of Tat on the dopaminergic system will help to elucidate the mechanisms by which HIV infection of the CNS induces neuropsychiatric, neurocognitive and neurological disorders that involve dopaminergic neurotransmission. Further, this will provide a discussion of the experiments needed to further these investigations, and may help to identify or develop new therapeutic approaches for the prevention or treatment of these disorders in HIV-infected individuals.

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Heroin Use and HIV Disease Progression: Results from a Pilot Study of a Russian Cohort

Cited by 9 publications

References 55 publications

The impact of prescribed opioids on CD4 cell count recovery among HIV‐infected patients newly initiating antiretroviral therapy

The impact of prescribed opioids on CD4 cell count recovery among HIV‐infected patients newly initiating antiretroviral therapy

Serum adiponectin in HIV-1 and hepatitis C virus mono- and co-infected Kenyan injection drug users

HIV, Tat and dopamine transmission

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