Abstract
In 1988, Welsby predicted that the “second phase” of epidemic HIV infection in developed countries would occur within the injecting drug using population. This has been borne out, with injecting drug users (IDUs) accounting for an increasing proportion of the cases of HIV infection and AIDS in the USA, North America and Europe (MMWR Update 1991; Salmaso et al. 1991; Des Jarlais et al. 1992). Although the clinical spectrum of HIV disease differs little between risk groups, there are a number of specific features relating to the HIV-infected injecting drug user which merit attention. However, before considering these clinical problems in more detail it is important to remember that IDUs are prone to a variety of medical conditions related to both drug abuse and the act of injecting. The subject of the narcotic addict as a medical patient has been well reviewed by Sapira (1968) and, more recently, by Novick (1992).
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsPreview
Unable to display preview. Download preview PDF.
References
Aguado JM, Castrillo JM (1987) Lymphadenitis as a characteristic manifestation of disseminated tuberculosis in intravenous drug abusers infected with human immunodeficiency virus. J Infect 14: 191
Arruda JAL, Kurtzman NA (1977) Heroin addiction and renal disease. Contrib Nephrol 7: 69–78
Ballet JJ, Sulcebe G, Couderc LJ et al. (1987) Impaired anti-pneumococcal antibody response in patients with AIDS-related persistent generalised lymphadenopathy. Clin Exp Immunol 68: 479–487
Beral V, Peterman TA, Berkelman RL, Jaffe HW (1990) Kaposi’s sarcoma among persons with AIDS: a sexually transmitted infection? Lancet i: 123–128
Berry CD, Hooton TM, Collier AC, Lukehart SA (1987) Neurological relapse after benzathine penicillin therapy for secondary syphilis in a patient with HIV infection. N Engl J Med 316: 1587–1589
Brettle RP, Gore SM, McNeil A (1992) Outpatient medical care of injection drug use related HIV. Int J STD AIDS 3: 96–100
Brown SM, Stimmel B, Taub RN, Kochwa S, Rosenfield RE (1974) Immunological dysfunction in heroin addicts. Arch Int Med 134: 1001–1006
Burger DM, Meenhorst PL, Koks CHW, Beijnen JH (1993) Drug interactions with zidovudine. AIDS 7: 445–451
Butz WC (1969) Pulmonary arteriole foreign body granulomata associated with angiomatoids resulting from the intravenous injection of oral medications, eg propoxyphene hydrochloride. J Forensic Sci 14: 317–326
Byrne MA, Taylor-Robinson D, Munday PE, Harris JRW (1989) The common occurrence of human papillomavirus infection and intraepithelial neoplasia in women infected by HIV. AIDS 3: 379–382
Cantor KP, Weiss SH, Goedert J, Battjes R (1989) HTLV-I/II seroprevalence and HIV/HTLV coinfection among IV drug abusers in the U.S. (abstract Th.A.P.18) In: Proceedings of the V International Conference on AIDS. Montreal, Canada
Cassidy WM, Govindarajan S, Gupta S, Valinluck B, Redeker AG (1989) Influence of HIV on chronic hepatitis B and D infection (abstract). Hepatology 10: 690
Castillo I, Bartolome J, Martinez MA, et al. (1989) Influence of HIV infection in hepatitis delta chronic carriers (abstract M.B.P.221). In: Proceedings of the V International Conference on AIDS. Montreal, Canada
Centers for Disease Control (1988) Continuing increase in infectious syphilis-United States. MMWR 37; 35–38
Centers for Disease Control (1988) Relationship of syphilis to drug use and prostitution in Conneticut and Philadelphia, Pennsylvania. MMWR 37: 755–758, 764
Chaisson RE, Slutkin G (1989) Tuberculosis and human immunodeficiency virus infection. J Infect Dis 159: 96–100
Chamot E, Hirschel B, Wintsch J, et al (1990) Loss of antibodies against hepatitis C in HIV-seropositive intravenous drug users. AIDS 4: 1275–1277
Chamot E, de Saussure Ph, Hirschel B, Deglen JJ, Perrin LH (1992) Incidence of hepatitis C, hepatitis B, and HIV infection among drug users in a methadone-maintenance programme. AIDS 6: 430–431
Cohen A (1977) A typology of drug addicts. National Drug Abuse Conference, San Francisco
Collignon PJ, Sorrell T (1987) Candidiasis in heroin abusers. J Infect Dis 155: 595
Conte D, Ferroni P, Lorini GP et al. (1987) HIV and HBV infection in intravenous drug addicts from northeastern Italy. J Med Vir 22: 299–306
Crane LR, Levine DP, Zervos MJ, Cummings G (1986) Bacteremia in narcotic addicts at the Detroit Medical Center. 1. Microbiology, epidemiology, risk factors, and empiric therapy. Rev Infect Dis 8: 364–372
Craven DE, Rixinger Al, Bisno AL, Goularte TA, McCabe WR (1986) Bacteremia caused by group G streptococci in parenteral drug abusers: epidemiological and clinical aspects. J Infect Dis 153: 988–992
Crovari P, Penco G, Valente A et al. (1988) HIV infection in two cohorts of drug addicts prospectively studied. Association of serological markers with clinical progression (abstract 4527 ). In: Proceedings of the IVth International Conference on AIDS. Stockholm, Sweden
Cushman P Jr, Sherman C (1974) Biologic false-positive reactions in serologic tests for syphilis in narcotic addiction. Am J Clin Path 61: 346–351
Cushman P Jr, Gupta S, Grieco MH (1977) Immunological studies in methadone maintained patients. Int J Addict 12: 241–253
Des Jarlais DC, Marmor M, Thomas P, Chamberland M, Zoll-Pazner S, Sencer DJ (1984) Kaposi’s sarcoma among four different AIDSs risk groups. N Engl J Med 310: 1119
Des Jarlais DC, Friedman SR, Marmor M et al. (1987) Development of AIDS, HIV seroconversion, and co-factors for T4 cell loss in a cohort of intravenous drug users. AIDS 1: 105–111
Des Jarlais DC, Friedman SR, Choopanya K, Vanichseni S, Ward TP (1992) International epidemiology of HIV and AIDS among injecting drug users. AIDS 6: 1053–1068
Dupont B, Drouhet E (1985) Cutaneous, ocular, and osteoarticular candidiasis in heroin addicts: new clinical and therapeutic aspects in 38 patients. J Infect Dis 152: 577–591
Egan VG, Crawford JR, Brettle RP, Goodwin GM (1990) The Edinburgh cohort of HIV-positive drug users: current intellectual function is impaired, but not due to early AIDS dementia complex. AIDS 4: 651–656
Ehm-I, Pauli G, Thiele B et al. (1989) Investigations of the presence of HTLV-I infection in intravenous drug abusers and homosexuals in the Federal Republic of Germany (abstract Th.A.P.29). In: Proceedings of the V International Conference on AIDS. Montreal, Canada
Esteban JI, Viladomiu L, Gonzalez A et al. (1989) Hepatitis C virus antibodies among risk groups in Spain. Lancet ii: 294–296
Farley TA, Hadler JL, Gunn RA (1990) The syphilis epidemic in Connecticut: relationship to drug use and prostitution. Sex Transm Dis 17: 163–168
Finnegan LP, Davenny K, Härtel D (1993) Drug use in HIV-infected women. In: Johnson MA, Johnstone FD (eds) HIV infection in women. Churchill Livingstone, Edinburgh, p133–155
Flegg PJ, Jones ME, MacCallum LR et al. (1989) Continued injecting drug use as a cofactor for progression of HIV (abstact M.A.P.92). In: Proceedings of the V International Conference on AIDS. Montreal, Canada
Flegg PJ, Brettle RP, Robertson JR, Clarkson RC, Bird AG (1991) β2-microglobulin levels in drug users: the influence of risk behaviour. AIDS 5: 1021–1024
Frieden TR, Sterling MPH, Pablos-Mendez A, Kilburn JO, Cauthen GM, Dooley SW (1993) The emergence of drug resistant tuberculosis in New York City. N Engl J Med 328: 521–526
Gachupin-Garcia A, Selwyn PA, Salisbury Budner N (1992) Population-based study of malignancies and HIV infection among injecting drug users in a New York City methadone treatment programme, 1985–1991. AIDS 6: 843–848
Giadelone A, Zani M, Barillari G et al. (1988) HTLV-I and HIV infection in drug addicts in Italy. Lancet ii: 753–754
Glassroth J, Adams G, Schmoll S (1987) The impact of substance abuse on the respiratory system. Chest 91: 596–602
Gorter RW, Vranizan KM, Osmond DH, Moss AR (1992) Differences in laboratory values in HIV infection by sex, race, and risk group. AIDS 6: 1341–1347
Hahn HH, Schweid AI, Beaty HN (1969) Complications of injecting dissolved methylphenidate tablets. Arch Int Med 123: 656–659
Hart GJ, Sonnex C, Petherick A et al. (1989) Risk behaviours for HIV infection among injecting drug users attending a drug dependency unit. Br Med J 298: 1081–1083
Hart GJ, Woodward N, Johnson AM, Tighe J, Parry JV, Adler MW (1991) Prevalence of HIV, hepatitis B and associated risk behaviours in clients of a needle-exchange in central London. AIDS 5: 543–547
Hattori T, Koito A, Takatsuki K et al. (1989) Frequent infection with human T-cell lymphotropic virus type 1 in patients with AIDS, but not in carriers of human immunodeficiency virus type 1. J AIDS 2: 272–276
Helpern M, Rho Y-M (1966) Deaths from narcotism in New York City. New York J Med 66: 2391–2408
Hicks CB, Benson PM, Lupton GP, Tramont EC (1987) Seronegative secondary syphilis in a patient infected with the human immunodeficiency virus (HIV) with Kaposi sarcoma: a diagnostic dilemma. Ann Int Med 107: 492–495
Ho A, Dole VP (1979) Pain perception in drug-free and in methadone-maintained human ex-addicts. Proc Soc Exp Biol Med 162: 392–395
Hopkins GB (1972) Pulmonary angiothrombotic granulomatosis in drug offenders. JAMA 221: 909–911
Housset C, Pol S, Carnot F et al. (1992) Interactions between human immunodeficiency virus-1, hepatitis delta virus and hepatitis B virus infections in 260 chronic carriers of hepatitis B virus. Hepatology 15: 578–583
Johns DR, Tierney M, Felsenstein D (1987) Alteration of the natural history of neurosyphilis by concurrent infection with the human immunodeficiency virus. N Engl J Med 316: 1569–1572
Johnston EH, Goldbaum LR, Whelton RL (1969) Investigation of sudden death in addicts, with emphasis on the toxicological findings in thirty cases. Med Ann D C 38: 375–380
Kaufman RE, Weiss S, Moore JD, Falcone V, Wiesner PJ (1974) Biological false positive serological tests for syphilis among drug addicts. Br J Vener Dis 50: 350–353
Kenner RM, Foley KM (1981) Patterns of narcotic use in a cancer pain clinic. Ann NY Acad Sci 362: 161–72
Khabbaz RF, Onorato IM, Cannon RO et al. (1992) Seroprevalence of HTLV-I and HTLV-II among intravenous drug users and persons in clinics for sexually transmitted diseases. N Engl J Med 326: 375–80
Klein RS, Selwyn PA, Maude D, Pollard C, Freeman K, Schiffman G (1989) Response to pneumococcal vaccine among asymptomatic heterosexual partners of persons with AIDS and intravenous drug users infected with HIV. J Infect Dis 160: 826–831
Kreek MJ, Garfield JW, Gutjahr CL, Guisti M (1976) Rifampin-induced methadone withdrawal. Ann Int Med 294: 1104–1106
Kreek MJ (1983) Factors modifying the pharmacological effectiveness of methadone. In: Research on the Treatment of Narcotic Addiction, Cooper JR, Altman F Brown BS, Czechowicz D (eds). Treatment Research Monograph Series DHSS Publication no (ADM) 83–1281, pp 95–107
Kreek MJ, Des Jarlais DC, Trepo G et al. (1987) Hepatitis delta antigenemia in intravenous drug abusers with AIDS (abstract Th.P.216). In: Proceedings of the I II International Conference on AIDS, Washington, DC
LaGuardia KD (1993) Other sexually transmitted disease: cervical intraepithelial neoplasia. In: Johnson MA, Johnstone FD (eds) HIV infection in women. Churchill Livingstone, Edinburgh, p 247–61
Lake-Baharr G, Bhat K, Goundarajan S (1989) HIV infection and delta hepatitis in intravenous drug addicts (abstract M.B.P.218) In: Proceedings of the V International Conference on AIDS. Montreal, Canada
Lazizi Y, Grongeot-Keros L, Delfraissy J-E et al. (1988) Reappearance of hepatitis B virus in immune patients infected with the human immunodeficiency virus. J Infect Dis 158: 666–667
Lettau LA, McCarthy JG, Smith MH et al. (1987) Outbreak of severe hepatitis due to delta and hepatitis B viruses in parenteral drug abusers and their contacts. N Engl J Med 317: 1256–1262
Lukehart SA, Hook EW III, Baker-Zander SA, Collier AC, Critchlow CW, Handsfield HH (1988) Invasion of the central nervous system by Treponema pallidum: implications for diagnoses and therapy. Ann Int Med 109: 855–862
Luttgens WF (1949) Endocarditis in “main line” opium addicts. Arch Int Med 83: 653–654
Marshall N, Hendtlass J (1986) Drugs and prostitution. J Drug Issues 16: 237–248
Martin P, Di Bisceglie AM, Kassianides C, Lisker-Melman M, Hoofnagle JH (1989) Gastroenterology 97: 1559–1561
McDonough RJ, Madden JJ, Falek A et al. (1980) Alteration of T and null lymphocyte frequencies in the peripheral blood of human opiate addicts: in vivo evidence for opiate receptor sites on T lymphocytes. J Immunol 125: 2539–2543
McKegney FP, O’Dowd MA, Feiner C, Selwyn P, Drucker E, Friedland GH (1990) A prospective comparison of neuropsychologic function in HIV-seropositive and seronegative methadone maintained patients. AIDS 4: 565–569
McLachlan C, Crofts N, Wodak A, Crowe S (1993) The effects of methadone on immune function among injecting drug users: a review. Addiction 88: 257–263
McMeeking AA, Holzman RS(1988) Group G streptococcal bacteremia and parenteral drug abusers. J Infect Dis 157: 612
Mientjes GH, Miedema F, van Ameijden EJ et al. (1991) Frequent injecting impairs lymphocyte reactivity in HIV-positive and HIV–negative drug users. AIDS 5: 35–41
MMWR (1991) Update: Acquired immunodeficiency syndrome-United States, 1981–1990. 40: 358–369
Monfardini S, Vaccher E, Pizzocara G et al. (1989) Unusual malignant tumours in 49 patients with HIV infection. AIDS 3: 449–452
Munoz-Fernandez S, Macia MA, Pantoja L et al. (1993) Osteoarticular infection in intravenous drug abusers: influence of HIV infection and differences with non drug abusers. Ann Rheum Dis 52: 570–574
Myer JA, Earnest MP (1984) Generalised seizures and cocaine abuse. Neurology 34: 675–687
Nelson KE, Vlahov D, Cohn S, Odunmbaku M, Lindsay A, Anthony JC, Hook III EW (1991) Sexually transmitted disease in a population of intravenous drug users: association with seropositivity to the human immunodeficiency virus. J Infect Dis 164: 457–463
Novick DM (1992) The medically ill substance abuser. In: Lowinson J, Ruiz P, Millman R (eds) Substance abuse: a comprehensive textbook, 2nd edn. Williams and Wilkins, Baltimore, MD, pp 657–674
O’Donnell AE, Pappas LS (1988) Pulmonary complications of intravenous drug abuse. Chest 94: 251–253
Overland ES, Nolan AJ, Hopewell PC (1980) Alteration of pulmonary function in intravenous drug abusers. Prevalence, severity, and characterization of gas exchange abnormalities. Am J Med 68: 231–237
Pallasch TJ, Joseph CE (1987) Oral manifestations of drug abuse. J Psych Drugs 19: 375–376
Pitchenik AE, Rubinson HA (1985) The radiographic appearance of tuberculosis in patients with the acquired immunodeficiency syndrome ( AIDS) and pre-AIDS. Am Rev Respir Dis 131: 393–396
Podzamczer D, Guidol F (1986) Systemic candidiasis in heroin abusers. J Infect Dis 153: 1182–1183
Polsky B, Gold JWM, Whimbey E et al. (1986) Bacterial pneumonia in patients with the acquired immunodeficiency syndrome. Ann Int Med 104: 38–41
Rao TKS, Nicastri AD, Friedman EA (1974) Natural history of heroin associated nephropathy. N Engl J Med 290: 19–23
Rao TKS, Filippone EJ, Nicastri AD et al. (1984) Associated focal and segmental glomerulosclerosis in the acquired immunodeficiency syndrome. N Engl J Med 310: 669–673
Rao TKS, Friedman EA, Nicastri AD (1987) The types of renal disease in the acquired immunodeficiency syndrome. N Engl J Med 316: 1062–1068
Reichman L, Felton C, Edsall J (1979) Drug dependence, a possible new risk factor for tuberculosis disease. Arch Int Med 139: 337–339
Rezza G, Menniti-Ippolito F, Lazzarin A et al. (1990) Psychoactive drug use and AIDS. JAMA 263: 372–373
Robert-Guroff M, Weiss SH, Gibbs WN et al. (1986) Prevalence of antibodies to HTLV-I, -II, and –III in intravenous drug abusers from an AIDS endemic region. JAMA 255: 3133–3137
Rolfs RT, Goldberg M, Sharrar RG (1990) Risk factors for syphilis: cocaine use and prostitution. Am J Public Health 80: 853–857
Ruggeri P, Sathe SS, Kapila R (1988) Changing patterns of infectious endocarditis in parenteral drug abusers with human immunodeficiency virus infections (abstract 8028 ). In: Proceedings of the IVth International Conference on AIDS. Stockholm, Sweden
Salmaso S, Conti S, Sasse H, and the Second Multicenter Study Group on Drug Users (1991) Drug use and HIV-1 infection: report from the second Italian multicenter study. J AIDS 4: 607–613
Sapira JD (1968) The narcotic addict as a medical patient. Am J Med 45: 555–585
Selwyn PA, Feingold AR, Härtel D et al. (1988) Increased risk of bacterial pneumonia in HIV-infected intravenous drug users without AIDS. AIDS 2: 267–272
Selwyn PA, Hartel D, Lewis VA et al. (1989) A prospective study of the risk of tuberculosis among intravenous drug users with human immunodeficiency virus infection. N Engl J Med 320: 545–550
Selwyn PA, Alcabes P, Hartel D et al. (1992) Clinical manifestations and predictors of disease progression in drug users with human immunodeficiency virus infection. N Engl J Med 327: 1697–1703
Shafer RW, Chirgwin KD, Glatt AE, Dahdouh MA, Landesman SH, Suster B (1991) HIV prevalence, immunosuppression, and drug resistance in patients with tuberculosis in an area endemic for AIDS. AIDS 5: 399–406
Shattock AG, Irwin FM, Morgan BM et al. (1985) Increased severity and morbidity of acute hepatitis in drug abusers with simultaneously acquired hepatitis B and hepatitis D virus infections. Br Med J 290: 1377–1380
Siegel H (1972) Human pulmonary pathology associated with narcotic and other addictive drugs. Human Pathol 3: 55–66
Siegel H, Helpern M, Ehrenreich T (1966) The diagnosis of death from intravenous narcotism. J Forensic Sci 11: 1–16
Slim J, Boghossian J, Perez G, Johnson E (1988) Comparative analysis of bacterial endocarditis in HIV positive and HIV negative intravenous drug abusers (abstract 8027 ). In: Proceedings of the IVth International Conference on AIDS. Stockholm, Sweden
Steinhoff MC, Auerbach BS, Nelson KE et al. (1991) Antibody responses to Haemophilus influenzae type B vaccines in men with human immunodeficiency virus infection. N Engl J Med 325: 1837–1842
Stern W, Subbarao K (1983) Pulmonary complications of drug abuse. Semin Roentgenol 18: 183–197
Stevens R, Wethers J, Samsonoff C, Berns D (1989) Human immunodeficiency and human T-lymphotropic virus infections associated with intravenous drug use (abstract T.A.P.53). In: Proceedings of the V International Conference on AIDS. Montreal, Canada
Sunderam G, McDonald RJ, Maniatis T, Oleske J, Kapila R, Reichman LB (1986) Tuberculosis as a manifestation of the acquired immunodeficiency syndrome. JAMA 256: 362–366
Theuer CP, Hopewell PC, Elias D, Schecter GF, Rutherford GW, Chaisson RE (1990) Human immunodeficiency virus infection in tuberculosis patients. J Infect Dis 162: 8–12
Tong TG, Pond SM, Kreek MJ et al. (1981) Phenytoin induced methadone withdrawal. Ann Int Med 94: 349–351
Unsworth DJ, Rowen D, Carne CA, Sonnex C, Baglin T, Brown DL (1993) Defective IgG2 response to Pneumovax in HIV seropositive patients. Genitourin Med 69: 373–376
Vento S, di Perri G, Luzzati R et al. (1989) Clinical reactivation of hepatitis B in anti-HBS-positive patients with AIDS. Lancet i: 332–333
Weiss SH, French J, Holland B et al. (1989) HTLV-I/II coinfection is significantly associated with risk of progression to AIDS among HIV+ intravenous drug abusers (abstract Th.A.0.23). In: Proceedings of the V International Conference on AIDS. Montreal, Canada
Weller IVD, Cohn D, Sierralta A et al. (1984) Clinical, biochemical, serological, histological and ultra-structural features of liver disease in drug abusers. Gut 25: 417–423
Welsby PD (1988) Caring for intravenous drug abusers with HIV infection: some lessons from Edinburgh. Postgrad Med J 64: 575–577
Whittaker S, Calsyn D, Saxon A, Freeman G Jr (1989) Sexual behaviours of intravenous drug users (abstract W.D.P.85). In: Proceedings of the V International Conference on AIDS. Montreal, Canada
Zagury D, Bernard J, Leonard L et al. (1986) Long term cultures of HTLV-III infected T cells: a model of cytopathology of T-cell depletion in AIDS. Science 231: 850–853
Zanetti AR, Galli C (1992) Seroprevalence of HTLV-I and HTLV-II. N Engl J Med 326: 1783
Zientara M, Moore S (1970) Fatal talc embolism in a drug addict. Human Pathol 1: 324–326
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1996 Springer-Verlag London Limited
About this chapter
Cite this chapter
Sonnex, C. (1996). Clinical Manifestations of HIV Infection and AIDS in Injecting Drug Users. In: Millar, A. (eds) Medical Management of HIV and AIDS. Springer, London. https://doi.org/10.1007/978-1-4471-3046-8_9
Download citation
DOI: https://doi.org/10.1007/978-1-4471-3046-8_9
Publisher Name: Springer, London
Print ISBN: 978-1-4471-3048-2
Online ISBN: 978-1-4471-3046-8
eBook Packages: Springer Book Archive