HIV/AIDS and substance abuse
HIV (human immunodeficiency virus) is a virus that attacks the immune system, leading to AIDS (acquired immunodeficiency syndrome), a condition characterized by severe immune system impairment and increased susceptibility to infections and certain cancers. Substance abuse, particularly through intravenous drug use, significantly heightens the risk of contracting HIV. This is primarily due to high-risk behaviors such as sharing needles or engaging in unprotected sex while under the influence of drugs, which can impair judgment and increase vulnerability to infection.
Globally, approximately 10 percent of new HIV infections occur among people who use intravenous drugs. These individuals often face additional health challenges, such as compromised immune function, due to the immunosuppressive effects of their substance use. Prevention strategies emphasize harm reduction techniques, including the use of clean needles and condom use during sexual activity.
Early detection through rapid HIV tests and effective treatment options, such as highly active antiretroviral therapy (HAART), can significantly improve health outcomes for those infected. Additionally, pre-exposure prophylaxis (PrEP) can help those at high risk of infection reduce their chances of contracting HIV. Overall, addressing the intersection of HIV/AIDS and substance abuse requires a culturally sensitive approach, recognizing the complexities of behavior, health, and societal factors involved.
HIV/AIDS and substance abuse
DEFINITION: The human immunodeficiency virus (HIV) is a pathogen. Acquired immunodeficiency syndrome (AIDS) is a disease caused by HIV and is characterized by progressive loss of immune function and the onset of opportunistic infections and a variety of cancers. Substance abuse can lead to high-risk behaviors, including unprotected sex and sharing drug needles, which increase the chances of HIV infection.
Causes
HIV causes AIDS. The virus enters immune cells, especially CD4 T-helper cells. Dormancy in those cells is possible, and activation of the virus to the replicative stage leads to the destruction of those immune cells. AIDS results when the infected person’s T-helper cell count is reduced to the extent that frequent opportunistic infections occur.
Risk Factors
Globally, around 10 percent of new HIV infections are in individuals who use intravenous drugs. In the US, these individuals account for one in every ten new HIV/AIDS diagnoses each year because drug abuse makes individuals vulnerable to infection. The sharing of needles and cocaine straws, for example, exposes users to each other’s body fluids. Also, users of intravenous drugs inject substances with immunosuppressive effects.
Immunologic defenses are also compromised by the simultaneous abuse of alcohol and tobacco and by personal neglect. The individual using intravenous drugs also may have impaired functioning of phagocytosis, reduced superoxide production, and reduced T-cell function, making the immune system ineffective at neutralizing the virus.
Also a risk factor for HIV infection is engaging in unprotected sex. Anal and vaginal penetration that causes injury can make a person vulnerable to HIV infection. Individuals who use drugs should avoid sexual activity while high because this raises the probability of HIV transmission.
Symptoms
The symptoms of HIV infection can be limited to the presence of anti-HIV antibodies after the reduction of T-helper cell count, otherwise rare cancers, such as Kaposi’s sarcoma, may result. Numerous bacteria, viruses, and fungi cause infection when the immune system is compromised by a reduced count of T-helper cells.
Screening and Diagnosis
Several rapid HIV tests are available. Each has received marketing approval from the US Food and Drug Administration. These tests are OraQuick Advance Rapid HIV-1/2 Antibody Test, manufactured by OraSure Technologies; Reveal G2 Rapid HIV-1 Antibody Test by MedMira; Uni-Gold Recombigen HIV Test, made by Trinity BioTech; and Multispot HIV-1/HIV-2 Rapid Test by Bio-Rad Laboratories. Each of these tests is an HIV enzyme immunoassay (EIA), and each is considered a screening test. Also, each test mandates additional confirmatory tests if the results are positive.
The basis of these antibody tests is the ability to detect anti-HIV antibodies in blood or oral fluid. Tests that use blood from a vein rather than oral fluid or a finger prick produce quicker results. Antibodies are products of the immune system that are produced in response to exposure to a virus and its component proteins. Antigens, or proteins from the virus, are embedded in or affixed to a filter. Because antibodies generated after exposure to HIV bind specifically to the viral proteins, antibodies in a person’s body fluids will bind to the filter exactly where the protein in the test kit was placed. To determine if antibodies from the sample are present on the filter, a second antibody from the test kit is added.
The secondary antibody specifically binds to the person’s antibodies. When an exposed person takes the test, the secondary antibody binds and creates a complex. The complex is created only when the person has anti-HIV antibodies in their fluids.
Detection of the complex on the filter paper is possible because the secondary antibodies in the test kit come with an enzyme linked to them. This enzyme catalyzes a reaction that results in a color change. The color is detected by visual inspection of the filter paper. Because these kits detect the presence of antibodies in the person’s fluids and not the virus, a positive result requires additional testing.
A nucleic acid test is needed to test the amount of the virus present in the body, also called the HIV viral load test. These tests also produce more accurate results closer in time to an instance of exposure than other tests.
The polymerase chain reaction works by detecting the genetic material unique to the HIV virus. This assay works by adding the necessary components for the replication of genetic material to the sample. If HIV genetic material is present, it will be multiplied to generate quantities that can be detected by a color-forming reaction, not unlike the EIA tests.
Treatment and Therapy
Highly active antiretroviral therapy (HAART) is the recommended treatment for HIV. HAART is administered as a combination of three or more anti-HIV medications from a minimum of two different classes. Nucleoside reverse transcriptase inhibitors comprise one class of anti-HIV drugs. These drugs inhibit the HIV enzyme reverse transcriptase by means of blockage with a nucleoside. Non-nucleoside reverse transcriptase inhibitors inhibit the same viral enzyme through means other than the addition of nucleosides. Protease inhibitors block another key enzyme from the virus.
Three additional classes of anti-HIV drugs block functions critical to the infection process. They are entry inhibitors, fusion inhibitors, and integrase inhibitors. Because each class of medications blocks the virus in a different way, the combination of several medications increases the chances of preventing viral replication and decreases the chance that the virus will survive long enough to mutate into a resistant form. Some of the drugs are available as a combination pill of two or more different anti-HIV medications from one or more classes.
For individuals who do not test positive for HIV/AIDS but regularly engage in high-risk behaviors, such as intravenous drug use and sharing needles, a version of HAART is available to help prevent future infection. Data indicates this prophylaxis treatment is effective in 90 percent of cases. Another prevention method, pre-exposure prophylaxis (or PrEP), reduces the transmission rate by 99 percent for sexual contact and by 74 percent for intravenous drug exposure.
Prevention
Prevention of HIV infection and the development of AIDS in individuals who abuse drugs centers around achievable behavior modifications. Because HIV is a blood-borne pathogen, one should not share needles. Syringe service programs are available in many communities to provide clean needles to individuals with substance use disorders to prevent the spread of HIV/AIDS. The virus also can be transmitted through sharing cocaine straws among users with damaged nasal mucosa.
Sexual activity also can expose participants to body fluids and, thus, the virus. The use of condoms is recommended. The close association between drug abuse and sex work makes prevention difficult. Despite numerous vaccination strategies tested for the prevention of AIDS or reduction of replication of the HIV virus, no effective vaccine has been found.
Bibliography
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