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"Opioid" and "HIV"

Andrew H Talal, Phyllis Andrews, Anthony Mcleod, Yang Chen, Clewert Sylvester, Marianthi Markatou, Lawrence S Brown
Background and aims: Despite high hepatitis C virus (HCV) prevalence, opioid use disorder (OUD) patients on methadone rarely engage in HCV treatment. We investigated the effectiveness of HCV management via telemedicine in an opioid substitution therapy (OST) program. Methods: OUD patients on methadone underwent biweekly telemedicine sessions between a hepatologist and physician assistant during the entire HCV treatment course. All pretreatment labs (HCV RNA, genotype and noninvasive fibrosis assessments) were obtained onsite and direct acting antivirals were co-administered with methadone using modified directly observed therapy...
October 17, 2018: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Alyona Mazhnaya, Ruthanne Marcus, Martha J Bojko, Alexei Zelenev, Iuliia Makarenko, Iryna Pykalo, Sergii Filippovych, Sergii Dvoriak, Frederick L Altice
BACKGROUND: The HIV treatment cascade is a crucial tool to guide HIV prevention and treatment strategies. The extent to which opioid agonist treatments (OATs) such as methadone and buprenorphine influence this cascade was examined in a nationwide study of people who inject drugs (PWID) in Ukraine. SETTING: Cross-sectional stratified survey of PWID followed by HIV and hepatitis C virus testing in 5 Ukrainian cities. METHODS: Opioid-dependent PWID (N = 1613) were sampled from January 2014 to March 2015...
November 1, 2018: Journal of Acquired Immune Deficiency Syndromes: JAIDS
Sarah Kim, Yun Kyung Hahn, Elizabeth M Podhaizer, Virginia D McLane, Shiping Zou, Kurt F Hauser, Pamela E Knapp
BACKGROUND: The collective cognitive and motor deficits known as HIV-associated neurocognitive disorders (HAND) remain high even among HIV+ individuals whose antiretroviral therapy is optimized. HAND is worsened in the context of opiate abuse. The mechanism of exacerbation remains unclear but likely involves chronic immune activation of glial cells resulting from persistent, low-level exposure to the virus and viral proteins. We tested whether signaling through C-C chemokine receptor type 5 (CCR5) contributes to neurotoxic interactions between HIV-1 transactivator of transcription (Tat) and opiates and explored potential mechanisms...
October 10, 2018: Journal of Neuroinflammation
Kellie J Goodlet, Monika T Zmarlicka, Alyssa M Peckham
Psychotropic medications are frequently co-prescribed with antiretroviral therapy (ART), owing to a high prevalence of psychiatric illness within the population living with HIV, as well as a 7-fold increased risk of HIV infection among patients with psychiatric illness. While ART has been notoriously associated with a multitude of pharmacokinetic drug interactions involving the cytochrome P450 enzyme system, the magnitude and clinical impact of these interactions with psychotropics may range from negligible effects on plasma concentrations to life-threatening torsades de pointes or respiratory depression...
October 8, 2018: CNS Spectrums
Lyuba Azbel, Martin P Wegman, Maxim Polonsky, Chethan Bachireddy, Jaimie Meyer, Natalya Shumskaya, Ainura Kurmanalieva, Sergey Dvoryak, Frederick L Altice
Purpose Within-prison drug injection (WPDI) is a particularly high HIV risk behavior, yet has not been examined in Central Asia. A unique opportunity in Kyrgyzstan where both methadone maintenance treatment (MMT) and needle-syringe programs (NSP) exist allowed further inquiry into this high risk environment. The paper aims to discuss these issues. Design/methodology/approach A randomly selected, nationally representative sample of prisoners within six months of release in Kyrgyzstan completed biobehavioral surveys...
September 10, 2018: International Journal of Prisoner Health
Anthony T Fojo, Catherine R Lesko, Keri L Calkins, Richard D Moore, Mary E McCaul, Heidi E Hutton, William C Mathews, Heidi Crane, Katerina Christopoulos, Karen Cropsey, Michael J Mugavero, Kenneth Mayer, Brian W Pence, Bryan Lau, Geetanjali Chander
Few studies examine how depression and substance use interact to affect HIV control. In 14,380 persons with HIV (PWH), we used logistic regression and generalized estimating equations to evaluate how symptoms of depression interact with alcohol, cocaine, opioid, and methamphetamine use to affect subsequent retention in care, maintaining an active prescription for ART, and consistent virologic suppression. Among PWH with no or mild depressive symptoms, heavy alcohol use had no association with virologic suppression (OR 1...
September 29, 2018: AIDS and Behavior
Nathan Kim, Susie Welty, Tania Reza, David Sears, Willi McFarland, Henry F Raymond
We examined three waves of National HIV Behavioral Surveillance surveys of persons who inject drugs (PWID) in San Francisco to assess meeting UNAIDS 90-90-90 targets. Diagnosis of PWID living with HIV increased from 64.4% in 2009 to 80.5% in 2015. Antiretroviral treatment among those diagnosed did not improve (63.8% in 2009, 62.9% in 2015). Programs in San Francisco have not achieved the first two UNAIDS targets for PWID by 2015. In a context of a rising opioid epidemic, there is urgent need for increased case finding of PWID living with HIV who are undiagnosed with rapid linkage to treatment...
September 26, 2018: AIDS and Behavior
Lisa Mustone Alexander, David Keahey, Katelyn Dixon
The treatment of patients with acute and chronic pain not attributed to cancer or end-of-life conditions is a challenge for many clinicians. Although CDC guidelines that focus on the primary care setting have provided critical recommendations, evidence-based guidance is lacking on optimal duration of opioid treatment for postoperative and acute care in specialty settings. Over the last 2 decades, the liberal use of opioids has resulted in many unintended consequences, including dependence and abuse, illicit distribution of legally and illegally prescribed opioid medication, progression to IV heroin and an epidemic of overdoses, and most recently an increase in the incidence of HIV among patients sharing syringes, frequently in communities with historically low HIV rates...
October 2018: JAAPA: Official Journal of the American Academy of Physician Assistants
Peter A Muennig, Megan Reynolds, David S Fink, Zafar Zafari, Arline T Geronimus
Although recent declines in life expectancy among non-Hispanic Whites, coined "deaths of despair," grabbed the headlines of most major media outlets, this is neither a recent problem nor is it confined to Whites. The decline in America's health has been described in the public health literature for decades and has long been hypothesized to be attributable to an array of worsening psychosocial problems that are not specific to Whites. To test some of the dominant hypotheses, we show how various measures of despair have been increasing in the United States since 1980 and how these trends relate to changes in health and longevity...
September 25, 2018: American Journal of Public Health
Gregory M Sindberg, Shannon E Callen, Santanu Banerjee, Jingjing Meng, Vanessa L Hale, Ramakrishna Hegde, Paul D Cheney, Francois Villinger, Sabita Roy, Shilpa Buch
Human Immunodeficiency Virus (HIV) pathogenesis has been closely linked with microbial translocation, which is believed to drive inflammation and HIV replication. Opioid drugs have been shown to worsen this symptom, leading to a faster progression of HIV infection to Acquired Immunodeficiency Syndrome (AIDS). The interaction of HIV and opioid drugs has not been studied at early stages of HIV, particularly in the gut microbiome where changes may precede translocation events. This study modeled early HIV infection by examining Simian Immunodeficiency Virus (SIV)-infected primates at 21 days or less both independently and in the context of opioid use...
September 21, 2018: Journal of Neuroimmune Pharmacology: the Official Journal of the Society on NeuroImmune Pharmacology
Maria Eugenia Socías, Evan Wood, Stephanie Lake, Seonaid Nolan, Nadia Fairbairn, Kanna Hayashi, Hennady P Shulha, Seagle Liu, Thomas Kerr, M-J Milloy
BACKGROUND AND AIMS: Cannabis use is common among people on opioid agonist treatment (OAT), causing concern for some care providers. However, there is limited and conflicting evidence on the impact of cannabis use on OAT outcomes. Given the critical role of retention in OAT in reducing opioid-related morbidity and mortality, we aimed to estimate the association of at least daily cannabis use on the likelihood of retention in treatment among people initiating OAT. As a secondary aim we tested the impacts of less frequent cannabis use...
September 20, 2018: Addiction
Ameer Abutaleb, Kenneth E Sherman
Hepatitis C virus (HCV) treatment in HIV/HCV co-infected individuals has renewed relevance given the ongoing opioid crisis and rise of new HIV and HCV infections associated with injection drug use. Patients co-infected with HIV and HCV demonstrate increased rates of hepatic fibrosis, progression to liver failure, and liver-related mortality. HIV co-infection does not impact outcomes of current HCV treatments, and patients should be treated the same as HCV mono-infected persons, though attention to drug:drug interactions is required...
September 20, 2018: Hepatology International
Zachery J Harter, Stuti Agarwal, Pranjali Dalvi, Norbert F Voelkel, Navneet K Dhillon
: Improved survival among HIV-1 infected individuals with the advent of antiretroviral therapy has clearly led to a greater prevalence of non-infectious complications. One of the most devastating sequelae in these individuals is the development of pulmonary arterial hypertension (PAH). Various epidemiological studies suggest a worse survival of HIV-PAH patients when compared to other forms of PAH. Given that only a subset and not all HIV-infected individuals develop HIV-PAH, suggests that an additional second hit of genetic or environmental triggers is needed for the development of PAH...
September 18, 2018: AIDS
Michael E Herce, Monde Muyoyeta, Stephanie M Topp, German Henostroza, Stewart E Reid
PURPOSE OF REVIEW: To advance a re-conceptualized prevention, treatment, and care continuum (PTCC) for HIV-associated tuberculosis (TB) in prisons, and to make recommendations for strengthening prison health systems and reducing HIV-associated TB morbidity and mortality throughout the cycle of pretrial detention, incarceration, and release. RECENT FINDINGS: Despite evidence of increased HIV-associated TB burden in prisons compared to the general population, prisoners face entrenched barriers to accessing anti-TB therapy, antiretroviral therapy, and evidence-based HIV and TB prevention...
November 2018: Current Opinion in HIV and AIDS
Zahid A Butt, Nabin Shrestha, Dionne Gesink, Michelle Murti, Jane A Buxton, Mark Gilbert, Robert F Balshaw, Stanley Wong, Margot Kuo, Jason Wong, Amanda Yu, Maria Alvarez, Hasina Samji, David Roth, Theodora Consolacion, Mark W Hull, Gina Ogilvie, Mark W Tyndall, Mel Krajden, Naveed Z Janjua
Background: Understanding differences in HIV incidence among people living with hepatitis C virus (HCV) can help inform strategies to prevent HIV infection. We estimated the time to HIV diagnosis among HCV-positive individuals and evaluated factors that could affect HIV-infection risk in this population. Patients and methods: The British Columbia Hepatitis Testers Cohort includes all BC residents (~1.5 million: about a third of all residents) tested for HCV and HIV from 1990 to 2013 and is linked to administrative health care and mortality data...
2018: Clinical Epidemiology
Andrew H Rogers, Lisa R LaRowe, Joseph W Ditre, Michael J Zvolensky
Persons living with HIV/AIDS (PLWHA) report high rates of clinically significant pain that is associated with several negative outcomes, including higher CD4 T-cell count, poor medication adherence, and substance use and misuse. Importantly, PLWHA also report elevated rates of both opioid and tobacco use, and these elevated rates have often been associated with increased pain experience. Although research suggests that negative affective responses to pain may be uniquely associated with substance misuse among individuals in the general population, little work has examined these relations among PLWHA...
January 2019: Addictive Behaviors
Katherine Fornili
In early April 2018, Dr. Maria Oquendo, President of the American Psychiatric Association, and Dr. Nora Volkow, Director of the National Institute on Drug Abuse, published a thought-provoking article in the New England Journal of Medicine about the role of suicide in the opioid overdose epidemic, referring to the relationship between them as a "hidden tragedy." Drs. Oquendo and Volkow drew our attention to the twinning of the opioid (and other drug) overdose and suicide epidemics, but these are not the first or only drug-related "twin epidemics...
July 2018: Journal of Addictions Nursing
Gina Dobbs, Susanne A Fogger
The worsening opioid epidemic ignites infectious disease development and transmission as opioids abused by insufflation and/or injection establish a pathway for infection to the user and propagate vulnerability to diseases. The phenomenon of the synergistic collision of epidemics intensifying the load of disease constitutes a syndemic. Merrill Signer (1994) voiced the term "syndemic" to characterize the complex nexus of politics, economics, psychosocial/environmental factors, and health disparities resulting in the inner-city AIDS crisis of the 1990s...
July 2018: Journal of Addictions Nursing
Rachel L Epstein, Vishakha Sabharwal, Elisha M Wachman, Kelley A Saia, Claudia Vellozzi, Susan Hariri, Benjamin P Linas
OBJECTIVES: The US National Viral Hepatitis Action Plan calls for major efforts to expand hepatitis C virus (HCV) diagnosis and treatment; prenatal care settings are potential venues for expanding HCV testing. We aimed to characterize the HCV diagnostic cascade for women and infants and investigate factors associated with linkage and follow-up. STUDY DESIGN: We used electronic health records for a 10-year cohort of 879 women with opioid use disorder from an obstetric clinic serving women with substance use disorders...
August 28, 2018: Journal of Pediatrics
Shreya S Bellampalli, Yingshi Ji, Aubin Moutal, Song Cai, E M Kithsiri Wijeratne, Maria A Gandini, Jie Yu, Aude Chefdeville, Angie Dorame, Lindsey A Chew, Cynthia L Madura, Shizhen Luo, Gabriella Molnar, May Khanna, John M Streicher, Gerald W Zamponi, A A Leslie Gunatilaka, Rajesh Khanna
The Federal Pain Research Strategy recommended development of non-opioid analgesics as a top priority in its strategic plan to address the significant public health crisis and individual burden of chronic pain facing >100 million Americans. Motivated by this challenge, a natural product extracts library was screened and identified a plant extract that targets activity of voltage-gated calcium channels. This profile is of interest as a potential treatment for neuropathic pain. The active extract derived from the desert lavender plant native to southwestern United States, when subjected to bioassay-guided fractionation afforded three compounds identified as pentacyclic triterpenoids, betulinic acid (BA), oleanolic acid, and ursolic acid...
August 28, 2018: Pain
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