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Many addicts need to "hit bottom" before they seek help; Pedro was always able to find "a trap door". In 1986, however, at age 29, he found himself at a turning point when he discovered he was infected with the AIDS virus. "At the time I was high on heroin, so I didn't really get it. When the diagnosis finally sank in, it was a shocking wake-up call."
Source: Moyers on Addiction: Close to Home
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Drug abuse not only weakens the immune system but is also linked to risky behaviors like needle sharing and unsafe sex. The combination greatly increases the likelihood of acquiring HIV-AIDS, hepatitis and many other infectious diseases.
| Drugs that can lead to HIV, Hepatitis and other infectious diseases: |
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| Selected Research Findings on HIV and Other Infectious Diseases |
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Cocaine's Effect on HIV Expression Can Be Modulated by the Kappa Opioids
The HIV virus acts on chemokine receptors to enter macrophages, glia and lymphocytes. Opiates and other drugs have been shown to compete with these sites and modify the toxicity of the virus. Therefore, many laboratories are focusing on the nature of this interaction to clarify the role of drugs in HIV toxicity or in the development of (HIV)-1-associated dementia (HAD). Cocaine abuse, for example, has been implicated as a cofactor in HAD. In this study, investigators tested the hypothesis that exposure of microglial cells, the resident macrophages of the brain, to cocaine would increase HIV-1 expression. Because kappa-opioid receptor (KOR) agonists have been shown to suppress neurochemical and neurobehavioral responses to cocaine and to inhibit HIV-1 expression in microglial cell cultures, the investigators hypothesized that KOR ligands would inhibit cocaine-induced HIV-1 expression. In this experiment, microglial cells were infected with HIV-and viral expression was quantified. Treating the microglia with the KOR inhibited viral expression. Consistent with the hypothesis, treatment of microglia with cocaine increased HIV-1 expression, and pretreatment of microglia with these KOR agonists as well as with the KOR-selective antagonist abolished cocaine-induced potentiation of HIV expression. Further analysis suggested that KOR ligands inhibit cocaine's stimulatory effect on viral expression by suppressing cocaine-induced activation of extracellular signal-regulated kinase1/2, reducing cocaine-enhanced up-regulation of the HIV-1 entry chemokine co-receptor CCR5. These findings suggest that in addition to its neurotoxic effects, cocaine could foster development of HAD by increasing viral expression in the brain and, importantly, this process is inhibited by KOR ligands. Gekker, G., Hu, S.X., Wentland, M.P., Bidlack, J.M., Lokensgard, J.R. and Peterson, P.K. Kappa-opioid Receptor Ligands Inhibit Cocaine-induced HIV-1 Expression in Microglial Cells. Journal of Pharmacology and Experimental Therapeutics,309, pp. 600-606, 2004.
Methamphetamine Dependence Increases Risk of Neuropsychological Impairment in HIV Infected Persons
HIV infection and methamphetamine (METH) dependence can each be associated with brain dysfunction. Little is known, however, about the cognitive effects of co-occurring HIV infection and METH dependence. NIDA researchers studied four groups of 200 participants: HIV+/METH, HIV-/METH, HIV+/No METH, and HIV-/ No METH. The groups were similar in age, education, and ethnicity, although there were significantly more females in the HIV-/No METH group. A comprehensive, demographically corrected neuropsychological battery was administered yielding a global performance score and scores for seven neuro-behavioral domains. Rates of global impairment were higher in the HIV+/METH (58%), HIV-/METH (40%) and HIV+/No METH (38%) groups compared to the HIV-/No METH (18%) group. A significant monotonic trend for global cognitive status was seen across groups, with the least impairment in the HIV-/No METH group and highest in the HIV+/METH+ group. The results indicate that HIV infection and METH dependence are each associated with neuropsychological deficits, which suggests that these factors in combination are associated with additive deleterious cognitive effects. This additivity may reflect common pathways to neural injury involving both cytotoxic and apoptotic mechanisms. Rippeth, J.D., Heaton, R.K., Carey, C.L., Marcotte, T.D., Moore, J.D., Gonzalez, R. and Wolfson, I.G., The HNRC Group. Methamphetamine Dependence Increases Risk of Neuropsychological Impairment in HIV Infected Persons. Journal of the International Neuropsychological Society. 10(1), pp.1-14, January 2004.
| Relevant NIDA Meetings |
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Dr. Jag Khalsa, DPMCDA, organized a symposium on The Role of Hormones and Nutrition in Drug Abuse and Co-occurring Infections: HIV and HCV, August 9-10, 2004, Bethesda Marriott Suites Hotel, Bethesda, MD. Past symposia discussed various metabolic and endocrine disorders and interventions for these complications of drug abuse and HIV/AIDS. This meeting presented the state-of-the-art information on the role of hormones and nutrition in drug abuse and co-infections of HIV and hepatitis C. It is anticipated that the proceedings will be published as a supplement in Clinical Infectious Diseases.
Dr. Ming Shih and Dr. Jacques Normand in collaboration with CTN's HIV/AIDS Special Interest Group organized a workshop entitled Current Epidemiology and Intervention Approaches for HIV/AIDS among Drug Users that was held in Bethesda, MD on August 12-13, 2004. The meeting presented current HIV epidemiology in the United States along with cutting edge approaches to structural and peer-driven intervention/prevention approaches among adult, adolescent, and minority drug using populations.
Drs. Robert Riddle, Jonathan Pollock and Jag Khalsa organized a meeting on RNAi as A Therapeutic Intervention For Treatment of Hepatitis C and HIV that was held on September 14-15th, 2004 at the Pooks Hill Marriott, Bethesda, MD.
Jacques Normand, Ph.D., and Elizabeth Lambert, M.Sc., of the Population-Based Health Intervention Unit of NIDA's CAMCODA organized a Workshop on New Dynamics of HIV Risk Among Drug-Using Men Who Have Sex With Men on March 1-2, 2004 in Bethesda, MD. The workshop brought together 15 NIDA researchers and experts to review information and findings from their currently-funded NIDA grants on HIV/AIDS and drug-using men who have sex with other men (MSM). Discussion sessions, led by Ron Stall, Ph.D. and Sevgi Aral, Ph.D., of the Centers for Disease Control and Prevention, focused on the research findings and on public health surveillance data that show the incidence of HIV and other sexually transmitted infections is increasing among drug-using MSM. The meeting concluded with recommendations to help NIDA facilitate a program of research on new dynamics of HIV risks among drug using MSM and prevention strategies to address them. The presentations and discussions of the participants are now being prepared as manuscripts for publication in a special issue of a peer-reviewed journal, expected to be available in the spring/summer of 2005. |
