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Further weakening the immune system increases the risk of additional infections while also raising the chance that HIV replication may increase. Even with proper medication, such as antiretroviral therapy ART , maintaining the best immune function possible is important to preventing disease progression. HIV patients who are heavy drinkers have diminished effectiveness of antiretroviral therapies.

Specifically, heavy drinkers are two to four times less likely to achieve a positive response while undergoing antiretroviral therapies Alcohol can also be detrimental to HIV patients due to its ability to decrease awareness and inhibit judgment. Excessive alcohol consumption can lead to liver damage, cirrhosis, and eventually culminate in end stage liver failure.

Because of the liver damage associated with ethanol consumption, alcohol is particularly problematic for other conditions that also affect the liver.

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HIV infection can exacerbate the liver damage caused by these other diseases. Many drugs used to treat HIV, such as antiretroviral drugs, carry a risk of liver toxicity. Because treatment of HIV takes priority over many other medical issues, patients will often receive treatment even in the presence of prior liver damage. Because it is so important to continue to treat HIV infection, it is also important to minimize any additional risks of liver damage. Alcohol is not the only substance that can be abused.

Drug Use and Viral Infections (HIV, Hepatitis)

Any chemical that changes the way the mind or body functions is defined as a drug. Substance abuse includes the use of illicit drugs, such as the misuse of prescription drugs or the use of recreational or illegal drugs. Drugs that have not been approved by a physician for medical use are characterized as recreational or illegal drugs. This text focuses on the drugs that are used by people with HIV and AIDS and how those drugs can negatively impact their health and prognosis.

Different drugs have different effects depending on the individual, with many well document negative health consequences for the general population. These effects range from increased risk of contracting HIV, as described above, to decreased effectiveness of medications and treatment. The rate of smoking is two to three times higher in HIV-positive adults than in the general population.

Other diseases of the respiratory tract include a candidal, or yeast infection of the mouth referred to as thrush or leukoplakia 14 , which is characterized by white sores in the mouth. Smoking can potentially produce an oral environment even more conducive to the development of these lesions. Other debilitating and potentially life-threatening diseases which disproportionately affect HIV-positive smokers include heart disease, stroke, cancer, and chronic obstructive pulmonary disease COPD. HIV and HIV treatment also increases the risks of some of certain conditions that are associated with smoking, such as osteoporosis, stroke, and heart attacks Illicit drug users have increased risk of contracting HIV through the use of used needles, shared injection supplies, contaminated injection drugs , and reduced judgment leading to a heightened chance of high risk behavior.

Illicit drug users with HIV are less likely to have access to effective treatment options. This lack of treatment options comes in the form of relatively few accommodating rehabilitation services to address the illicit drug use as well as limited access to clinics and antiretroviral therapies to treat their HIV. Antiretroviral therapies must be maintained in order to keep the viral load low and reduce the likelihood of serious consequences and development of AIDS.

Illicit drug use creates a barrier to consistent management of HIV, causing skipped treatments, incorrect dosages, and overall reduced effectiveness of treatment. Non-injection drugs are more likely to be associated HIV transmission by increasing the likelihood of risky behavior such as unprotected sex or sex with multiple partners. Various forms of amphetamine can also be abused via an intravenous route of administration.

It is not known whether any of these drugs directly interfere with antiretroviral therapies. Marijuana, other stimulants, and street or club drugs e. This is particularly true of amphetamine and amyl nitrate poppers which may be used to enhance sexual pleasure. Injection drugs are the second leading cause of HIV infection, preceded only by unprotected sex.

Both of these risk factors can be attributed to illicit drug use including heroin, cocaine, stimulants and other drugs. These risks disproportionately affect certain populations. For example, illicit drug use is more common in people living in poverty, people suffering from mental illness, and abuse survivors.

Gay men are also at an increased risk of illicit drug use , potentially due to the heightened risk of discrimination and mental health issues. The most obvious risk of HIV associated with illicit drug use is from the sharing of needles. Although needle exchange programs can be helpful, and exist to encourage the use of clean needles among injection drug users, drugs such as heroin and methamphetamine continue to be abused via non-sterile injection, promoting the transmission of HIV among users who share used needles.

Although illicit drugs may not interact directly with many antiretroviral treatments, the use of illicit drugs can interfere with treatment schedules. Illicit drug use can disrupt daily activities, potentially interfering with adherence to treatment programs. Illicit drug use also increases the risk of depression and mental illness.

For patients in recovery from illicit drug use, a relapse episode can bring back all of the risks associated with illicit drug use. Individuals who are concerned about possible punishments for illegal drugs are less likely to come forward for treatment. This fear of stepping forward decreases the likelihood of a person seeking treatment and increases the chances that HIV may be passed to other people.

This environment creates a cycle where people are more likely to engage in risky behavior as a result of their drug use and they are more likely to remain in their environment out of a fear of punishment. Furthermore, some medical providers are more reluctant to provide equal services to someone who is actively abusing illicit drugs since it is unlikely that the patient will be able to adhere to an effective and successful treatment regimen.

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Substance Abuse & HIV/AIDS

In some cases, the use of illicit drugs or the medications used for recovery from illicit drug use may increase the risk of side effects from antiretroviral therapies. However, despite these issues, HIV medications can remain effective in drug users. A study examined the cognitive impairment among control patients, HIV-positive individuals, methamphetamine users, and HIV-positive methamphetamine users This study found that either methamphetamine or HIV caused cognitive impairment when compared to the control group, but the cognitive impairment was significantly worse in the HIV-positive methamphetamine users.

This indicates that the use of methamphetamines may accelerate the cognitive decline associated with HIV infection. Cocaine use has been shown to accelerate HIV disease progression An active HIV infection is often measured by the number of active viral particles. Even in cases where the viral load is equal between cocaine users and control patients, the CD4 T cell population was reduced in the cocaine users While adherence to treatment is always a concern in the context of illicit drug use, adherence to antiretroviral therapy is not sufficient to manage HIV in the context of cocaine use.

These studies indicate that treatment for substance abuse is a necessary part of an effective HIV treatment program. In many cases, substance abuse is a causal factor for HIV infection. For some illicit drugs, including methamphetamine and cocaine, drug use can have adverse consequences on HIV and other disease progression. Illicit drug users are at increased risk of contracting HIV through unprotected sex or through shared supplies for injection drugs. Complications range from pulmonary infections in smokers to lapses in medications for illicit drug users.

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Several effective treatments for substance abuse exist. Effective substance abuse programs and treatments make this a preventable illness with multiple treatment options available. Termination of substance abuse can be a painful and debilitating process.

It is important to seek treatment immediately to reduce the associated risks and to receive help in controlling substance abuse. Although various medications can help the process and reduce cravings, withdrawal from illicit drugs or alcohol can lead to intense cravings, fever, sweating, nausea, vomiting, and pain throughout the body. For some types of substance abuse including that of alcohol and benzodiazepines the process of withdrawal can be quite severe and, even, life threatening.

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Getting help through the withdrawal process can make the process easier and also lead to additional opportunities for long-term mental health care to reduce the risk of relapse. The combination of these factors can increase risks of many dangerous infections and cancers and can complicate treatment options. Effective treatment of substance abuse is critical in all individuals and can lead to an improved quality of life.

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For anyone suffering from either of these conditions, the best option is too seek out qualified medical care and effective professional substance abuse treatment. References American Psychiatric Association. Washington DC: Author; Although the total thyroxine and total tri-iodothyronine levels were lower, the levels of free thyroxine and free triiodothyroxine were slightly but not significantly higher. He suggested that substance abuse could also interfere with endocrine function.

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With regard to interventions for endocrine disorders, Shalender Bhasin University of California, Los Angeles see the article by Bhasin [ 22 ] in this supplement reported on the effects of testosterone on regional fat distribution and discussed the mechanisms of anabolic effects on muscle. He showed that replacement doses of testosterone decrease fat mass in men by inhibiting adipogenic differentiation. Replacement doses of testosterone are associated with a small reduction or no change in plasma high-density lipoprotein cholesterol levels.

Results from epidemiological studies have shown an inverse relationship between serum free testosterone levels and visceral fat mass and the risk of heart disease and type 2 diabetes mellitus. According to Bhasin, the hypothesis that physiological testosterone replacement might improve insulin sensitivity and retard atherosclerosis in HIV-infected men with fat redistribution syndrome should be tested in prospective, placebo-controlled clinical trials. Kathleen Mulligan University of California, San Francisco; article may appear elsewhere noted that, because rHGH is an approved treatment for HIV-associated wasting in augmenting lean body mass , it has a potential for reducing fat mass, particularly in the dorsocervical and abdominal regions.

On the basis of data from the metabolic ward studies of the effects of open-label rHGH treatment on glucose and carbohydrate metabolism both in patients with classic wasting and in those with central fat accumulation, she showed that, in both groups, rHGH treatment produced sustained increases in lipid oxidation consistent with increases in whole-body lipolysis and decreases in body fat stores. In HIV-infected subjects with fat accumulation, rHGH improved lipid profiles but worsened both peripheral and hepatic glucose homeostasis during fasting and hyperinsulinemia.

The combined implications of these positive and negative metabolic effects for cardiovascular disease risk during the current treatment era, as well as the metabolic effects of lower doses of rHGH, warrant further study. The subject of CAM is not taught widely in medical schools, nor are complementary and alternative therapies generally available in medical colleges and hospitals in the United States. Numerous trials are currently under way to test alternative therapies in the treatment of the metabolic abnormalities of HIV. Ernst suggested that integrative medicine consisting of a clinical approach that combines the strengths of CAM should be considered for the treatment of ME complications of HIV infection and drug use.

These range from disorders of lipid, carbohydrate, and endocrine metabolism lipodystrophy and hyperinsulinemia to nutritional deficiencies. Interventions ranging from micronutrient supplementation to hormone testosterone replacement and rHGH therapy have been used effectively in the treatment of many of these complications. The panel, however, recommended that additional research is warranted to determine the nature and extent of problems and to design better and effective therapies.

Influence of body composition on diabetes and atherosclerosis and linkage of treatment to outcomes. Risk factors for the development of ME disorders in HIV-infected and uninfected drug users worldwide, with emphasis on children and women. Oxford University Press is a department of the University of Oxford.