Substance Abuse, HIV-1 and Hepatitis

Abstract

During the course of human immunodeficiency virus type 1 (HIV-1) disease, the virus has been shown to effectively escape the immune response with the subsequent establishment of latent viral reservoirs in specific cell populations within the peripheral blood (PB) and associated lymphoid tissues, bone marrow (BM), brain, and potentially other end organs. HIV-1, along with hepatitis B and C viruses (HBV and HCV), are known to share similar routes of transmission, including intravenous drug use, blood transfusions, sexual intercourse, and perinatal exposure. Substance abuse, including the use of opioids and cocaine, is a significant risk factor for exposure to HIV-1 and the development of acquired immune deficiency syndrome, as well as HBV and HCV exposure, infection, and disease. Thus, coinfection with HIV-1 and HBV or HCV is common and may be impacted by chronic substance abuse during the course of disease. HIV-1 impacts the natural course of HBV and HCV infection by accelerating the progression of HBV/HCV-associated liver disease toward end-stage cirrhosis and quantitative depletion of the CD4+ T-cell compartment. HBV or HCV coinfection with HIV-1 is also associated with increased mortality when compared to either infection alone. This review focuses on the impact of substance abuse and coinfection with HBV and HCV in the PB, BM, and brain on the HIV-1 pathogenic process as it relates to viral pathogenesis, disease progression, and the associated immune response during the course of this complex interplay. The impact of HIV-1 and substance abuse on hepatitis virus-induced disease is also a focal point.

Human rights and access to hepatitis C treatment for people who inject drugs

“…Coinfection with HIV is extremely common, with some 90% of HIVpositive PWID also living with HCV (Vickerman et al, 2013). HIV infection accelerates HCV disease progression, increasing risk for cirrhosis twenty-fold and for hepatocellular carcinoma by a factor of five (Parikh et al, 2012).…”

Continued Substance Use Among People Living With HIV–Hepatitis-C Co-Infection and Receiving Antiretroviral Therapy

“…Liver disease has emerged as a common cause of death in HIV infected persons, with liver-related mortality closely associated with Hepatitis C virus (HCV) co-infection (Prakash, Mason, Luftig, & Bautista, 2002). An estimated four to five million people in the world are living with HIV-HCV co-infection (Parikh et al, 2012). Furthermore, the hepatotoxicity of antiretroviral therapy (ART) and substance use places added strain on the liver with the potential to exacerbate organ damage.…”

Coinfection with Hepatitis C Virus among HIV-1-Infected Individuals Increases Proinflammatory Cytokines and HIV-1 Disease Severity

“…Within the United States, from the approximate 1.2 million HIV-1-infected individuals, about 25% of these are co-infected with HCV [39]. The interplay between both the viruses is complex and usually leads to accelerated forms of HIV-1 disease as well as HCV disease [21]. In fact, some recent reports have suggested that HCV-related deaths are greater than HIV-1-related deaths in the United States, and that the HIV-1/HCV co-infected individuals are the ones bearing a significant portion of the mortality [40].…”

“…In addition, the varied immune response during HIV-1 and HCV infections as well as modulation of certain cytokines and chemokines such as IFN-γ, MCP-3, and MIP-3α, are significant factors in the altered pathogenesis of HIV-1 and HCV coinfection [20,21]. In a decade long study comparing HIV-1 mono-infected individuals versus HIV-1 and HCV co-infected individuals, the coinfected individuals showed an increased prevalence of multiple neurologic disorders, 60% in the co-infected individuals as compared to the 46% in the HIV-1 mono-infected individuals.…”