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"Opioid" and "HIV"

Song Cai, Shreya Sai Bellampalli, Jie Yu, Wennan Li, Yingshi Ji, E M Kithsiri Wijeratne, Angie Dorame, Shizhen Luo, Zhiming Shan, May Khanna, Aubin Moutal, John M Streicher, A A Leslie Gunatilaka, Rajesh Khanna
For an affliction that debilitates an estimated 50 million of U.S. adults, the current chronic pain management approaches are inadequate. The Centers for Disease Control and Prevention have called for a minimization in opioid prescription and use for chronic pain conditions, and thus, it is imperative to discover alternative non-opioid based strategies. For the realization of this call, a library of natural products was screened in search of pharmacological inhibitors of both voltage-gated calcium channels and voltage-gated sodium channels, excellent targets due to their well-established roles in nociceptive pathways...
December 7, 2018: ACS Chemical Neuroscience
Christopher Akiba, Jeremy C Kane, Stephanie Skavenski van Wyk, Ravi Paul, Chombalelo Mukunta, Laura K Murray
Introduction: Although the World Health Organization (WHO) has recommended guidelines for the treatment of opioid dependence, there are myriad challenges to successfully implementing such guidelines in resource constrained settings, such as in low and middle-income countries (LMICs). To highlight these challenges, this paper presents a clinical case study of an adolescent study participant in a randomized controlled trial comparing two counseling programs in Lusaka, Zambia. Case description: This 15 year-old male reported smoking marijuana and heroin daily, and injecting heroin monthly (while needle sharing)...
December 2018: Addictive Behaviors Reports
Helen Laycock, Vanessa Crawford, Andrew Sc Rice, Sarah Cox
People living with HIV represent a unique aging population, living with a chronic condition associated with significant pain. A number take high dose, long-term opioids to manage moderate to severe chronic pain, presenting specific risks. This article highlights the size and impact of this problem and outlines the service objectives and set up of a specialist clinic to manage people living with HIV on high dose opioids, alongside its successes and learning points.
December 3, 2018: Pain Management
Colleen L Barry, Susan G Sherman, Elizabeth Stone, Alene Kennedy-Hendricks, Jeff Niederdeppe, Sarah Linden, Emma E McGinty
BACKGROUND: Safe consumption sites are spaces where people can legally use pre-obtained drugs under medical supervision and are currently in operation in Canada, Australia and Western Europe. These sites are effective in reducing opioid overdose mortality and other harms associated with opioid use, such as HIV infection, and increasing drug treatment entry. Various U.S. communities are considering establishing safe consumption sites, however, only 29% of U.S. adults support their legalization...
November 20, 2018: International Journal on Drug Policy
Robert Heimer, Kathryn Hawk, Sten H Vermund
The current opioid crisis in the United States has emerged from higher demand for and prescribing of opioids as chronic pain medication. This led to massive diversion of prescription opioids into illicit markets. A peculiar tragedy is that many health professionals prescribed opioids in a misguided response to legitimate concerns that pain was under-recognized and undertreated. The crisis grew not only from over-prescribing, but also from other sources, including a lack of research into non-opioid pain management, ethical lapses in corporate marketing, historical stigmas directed against people who use drugs, and failures to deploy evidence-based therapies for opioid addiction and to comprehend the limitations of supply side regulatory approaches...
November 17, 2018: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Natalia Gnatienko, Jennifer A Wagman, Debbie M Cheng, Angela R Bazzi, Anita Raj, Elena Blokhina, Olga Toussova, Leah S Forman, Dmitry Lioznov, Carly Bridden, Meg Sullivan, Kendall Bryant, Jeffrey H Samet, Judith I Tsui
OBJECTIVE: To describe the frequency of being partnered and having an HIV-negative partner, and whether this differed by gender, among a cohort of persons living with HIV (PLWH) who have ever injected drugs; to describe awareness of HIV pre-exposure prophylaxis (PrEP) and perceived partner interest in PrEP. SETTING: Secondary analyses of an observational cohort study of PLWH who have ever injected drugs in St. Petersburg, Russia. METHODS: Primary outcomes were 1) being partnered and 2) being in a serodiscordant partnership...
2018: PloS One
Matthew A Miclette, Jared A Leff, Isabella Cuan, Jeffrey H Samet, Brendan Saloner, Gary Mendell, Yuhua Bao, Michael A Ashburn, Marcus A Bachhuber, Bruce R Schackman, Daniel E Polsky, Zachary F Meisel
Drug overdose deaths involving opioids have surged in recent years and the economic cost of the opioid epidemic is estimated to be over $500 billion annually. In the midst of calls for declaring a national emergency, health policy decision makers are considering the best ways to allocate resources to curb the epidemic. On June 9, 2017, 116 invited health researchers, clinicians, policymakers, health system leaders, and other stakeholders met at the University of Pennsylvania to discuss approaches to address the gaps in evidence-based substance use disorder policy and practice, with an emphasis on the opioid epidemic...
November 13, 2018: Addiction Science & Clinical Practice
Arune Kontautaite, Daria Matyushina-Ocheret, Maria Plotko, Mikhail Golichenko, Mart Kalvet, Lena Antonova
BACKGROUND: Estonia continues to have the highest prevalence of HIV among people who inject drugs, and the highest overdose mortality, in the European Union. In August 2017, the Eurasian Harm Reduction Association (EHRA), the Canadian HIV/AIDS Legal Network (CHALN), and the Estonian Association of People Who Use Psychotropic Substances (LUNEST) conducted a study in Estonia to assess the situation regarding the human rights of women who use drugs and/or living with HIV. METHODS: The research methodology, developed by EHRA and CHALN, comprised in-depth interviews with 38 drug-dependent women conducted between August 8 and 14, 2017, in Tallinn and Ida-Viru county...
November 6, 2018: Harm Reduction Journal
Joseph W Ditre, Lisa R LaRowe, Peter A Vanable, Martin J De Vita, Michael J Zvolensky
Pain, tobacco cigarette smoking, and prescription opioid misuse are all highly prevalent among persons living with HIV (PLWH). Smoking and pain medication misuse can lead to deleterious outcomes, including more severe pain and physical impairment. However, we are not aware of any interventions that have attempted to address these issues in an integrated manner. Participants (N = 68) were recruited from an outpatient infectious disease clinic and randomized to either a computer-based personalized feedback intervention (Integrated PFI) that aimed to increase motivation, confidence, and intention to quit smoking, and decrease intentions to misuse prescription analgesic medications, or a Control PFI...
October 27, 2018: Behaviour Research and Therapy
Carlos Del Rio, Wendy S Armstrong
In no field of medicine has advocacy, including physician advocacy, been more crucial in shaping policy for delivery of care than in HIV/AIDS. Although the historic tradition is strong, there is an urgent need to re-energize advocacy efforts nationally and internationally to support programs that fund care, change policies that perpetuate stigma and discrimination, and change the public perception that the HIV/AIDS crisis is over. Established programs that require ongoing advocacy attention include the Ryan White Comprehensive AIDS Resources Emergency Act, a US program that serves as a payer of last resort for care for patients with HIV infection, and international programs like the President's Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria...
September 2018: Topics in Antiviral Medicine
R Douglas Bruce
Available data indicate that opioid substitution treatment can successfully reduce rates of HIV transmission and that patients receiving such treatment can adhere to therapies for HIV, hepatitis C, and tuberculosis infection. Integration of opioid substitution treatment into the HIV clinic setting can make such treatment easier and improve retention in treatment. This article summarizes a presentation by R. Douglas Bruce, MD, MA, MS, at the IAS-USA continuing education program held in Chicago, Illinois, in May 2018...
September 2018: Topics in Antiviral Medicine
Ansley Lemons, Nicholas DeGroote, Alejandro Peréz, Jason Craw, Margaret Nyaku, Dita Broz, Christine L Mattson, Linda Beer
BACKGROUND: People living with HIV are prescribed opioids more often and at higher doses than people who do not have HIV, and disproportionately experience risk factors for substance use disorder, which suggests they could be at increased risk for the misuse of opioids. Researchers also suggest that opioid misuse negatively affects various HIV clinical outcomes, increasing the risk of transmission to partners with an HIV-negative status. METHODS: We calculated weighted percentages and 95% confidence intervals to estimate substance use characteristics among a probability sample of 28,162 HIV-positive adults receiving medical care in the US who misused opioids (n=975)...
October 23, 2018: Journal of Acquired Immune Deficiency Syndromes: JAIDS
Roman Shrestha, Frederick L Altice, Michael M Copenhaver
BACKGROUND: Opioid agonist therapies with methadone are associated with higher levels of adherence to antiretroviral therapy (ART), yet no studies have explored factors associated with optimal ART levels in HIV-positive patients on methadone maintenance treatment (MMT), including explanatory pathways using mediation analysis. SETTING: Participants included 121 HIV-positive, methadone-maintained patients who reported HIV-risk behaviors and were taking ART. METHODS: Participants were assessed using an audio-computer assisted self-interview (ACASI)...
October 23, 2018: Journal of Acquired Immune Deficiency Syndromes: JAIDS
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
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