News (Updated July 27,
2003)
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Islamabad, July 21 (IANS) Pakistan is paying an inadvertent price for the war on terror in Afghanistan - a growing incidence of HIV, a report here said Monday.
A heightened security scenario after the war began led to more drug users sharing needles, contributing to the spread of the disease, The News says quoting a new study.
Published in the July issue of the U.S. journal "Drug and Alcohol Dependence", the study suggests that due to needle sharing, the risk of exposure to HIV and other blood-borne diseases among drug users had increased significantly in Pakistan after the war began.
The study conducted by researchers from the Johns Hopkins Bloomberg School of Public Health, Baltimore, followed 244 heroin users who registered for treatment with a Lahore-based NGO between August and October 2001.
It found that 56 percent of drug users who registered before the war had shared needles and the number rose to 76 percent after the war began.
Steffanie Strathdee, lead author of the study, attributes this to the increased presence of security forces in the build-up to the war.
"There is some evidence to suggest that increased police presence may have led some drug users to engage in more covert needle-sharing," Strathdee contended.
Pakistan's National AIDS Control Programme estimates that between 70,000 and 80,000 people, or 0.1 percent of adults, are HIV positive.
But Strathdee warned against complacency.
"All the conditions exist for a widespread epidemic, including low AIDS awareness, low condom use, high rates of needle-sharing and the practice of some blood donor clinics to pay blood donors," she said.
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Thu Jul 24,10:33 AM ET
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NEW YORK (Reuters Health) - Even with the widespread use of powerful anti-AIDS) drugs, many HIV-positive patients are still being hospitalized because their lungs are infected with the organism Pneumocystis carinii. Ongoing substance abuse appears to be the reason that this is happening.
People with weakened immune systems, such as AIDS patients, are prone to pneumonia caused by the Pneumocystis parasite, or PCP. In the early days of the HIV epidemic, many AIDS patients succumbed to the infection, but since effective anti-HIV drugs became available in the mid-90s PCP has become much less of a problem.
However, physicians at Cook County Hospital in Chicago, led by Dr. Joseph Pulvirenti, have found that PCP is far from gone. They examined the charts of 104 HIV-infected patients with PCP who were hospitalized there between 1998 and 2001, to get an idea of why these patients were still susceptible to the infection.
According to their report in the journal AIDS Patient Care, only half of the patients knew they were infected with HIV, and only five were taking anti-HIV drugs. More than two thirds had documented substance abuse.
Fifteen patients (14%) died while in the hospital.
The authors followed 71 patients who were subsequently treated in their outpatient clinic. A modern anti-HIV regimen was prescribed for 58 patients, but only 34 achieved adequate suppression of HIV in their blood. A poor response to treatment was tied to ongoing substance abuse and failure to take the prescribed medication.
Dr. Pulvirenti's group suggests that community educational programs and easier access to HIV testing and medical care could prevent hospitalization for PCP. Patients who continue to use illicit drugs may benefit from drug rehabilitation, they add, and by participation in a program in which they are directly observed taking their medication.
SOURCE: AIDS Patient Care and STDs, June 2003.
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Thu Jul 24,10:28 AM ET
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NEW YORK (Reuters Health) - HIV-infected patients have a higher risk of common coronary heart disease risk factors compared with individuals without HIV infection, according to a report by French investigators.
HIV-infected patients are thought to have an increased rate of heart disease, the authors explain. Side effects of anti-HIV drugs, such as higher cholesterol levels, have been implicated in increasing the risk of heart disease. However, few studies have compared these patients with people of the same age from the general population.
Dr. Genevieve Chene from Universite Victor Segalen Bordeaux 2, France, and associates evaluated risk factors for cardiovascular disease in 223 HIV-infected patients who were being treated with an anti-HIV regimen that contained a protease inhibitor. These patients were compared with 527 patients in the general population who were not HIV-infected. All of the subjects were between 35 and 44 years old.
The HIV-infected men were more likely to smoke, have a higher waist-to-hip ratio, and a higher triglyceride level than the men in the general population, the authors report. Average HDL "good" cholesterol levels and the frequency of high blood pressure were lower among HIV-infected men.
Similar trends were seen among women infected with HIV, the report indicates, but HIV-infected women also had higher total cholesterol levels than did women in the comparison group.
The estimated 5-year risk of developing coronary heart disease was 20% higher than the general population among HIV-infected men and 59% higher among HIV-infected women, the researchers note. A significant percentage of the increased risk (65% among men and 29% among women) could be attributed to the higher smoking rates.
These trends were similar in a group of 45- to 54-year-old men infected with HIV, the report indicates. This group showed a 22% higher risk of coronary heart disease than did the comparison group.
"Risk assessment for cardiovascular disease should be a part of routine HIV care," the investigators write in the July 15th issue of Clinical Infectious Diseases. "This should include not only laboratory abnormalities but also assessment of smoking habits, exercise activity, and family history of cardiovascular disease."
"Although absolute coronary heart disease risk remains low in HIV-infected patients treated by antiretrovirals, smoking cessation should seriously be considered," Dr. Chene told Reuters Health. Abnormal cholesterol levels "only marginally account for the increased risk in this population compared to uninfected patients, she continued.
Overall, Dr. Chene added, "HIV-infected patients should be aware that they have, on average, a slightly higher risk of coronary heart disease."
SOURCE: Clinical Infectious Disease 2003.