Development of HIV infection epidemic among intravenous drug users in the Sverdlovsky region

The Sverdlovsky region takes the fourth place among the 89 subjects of the Russian Federation by the number of registered cases of HIV infection. Drug addiction has reached an excessive scale in this region: according to the data of express evaluation carried out by the Regional Narcological Hospital and the Regional AIDS Center, not less than 7-8% of persons aged 15-30 years constantly use injection drugs. The large-scale epidemic of injection drug addiction has led to the rapid spread of HIV among addicts. The first penetration of HIV into this population took place in 1996 and, starting from the year 2000, rapid, development of the epidemic began, taking the character of an avalanche. The peak of new cases of HIV infection fell on 2001 (9,230 cases were registered). The concentrated stage of the epidemic development is observed in the region at present, the prevalence of HIV infection among drug addicts being 13.8%. Children born from HIV-infected drug addicted mothers now represent a new risk group due to great difficulties in the prophylaxis of the vertical virus transmission.     

The epidemic of human immunodeficiency virus-caused infection among users of psychotropic preparations in Russia

The development of the epidemic of HIV infection among the intravenous injecting users of psychotropic substances in Russia in 1994-1999 is described on the basis of the data provided by territorial centers for the prevention and control of AIDS. In addition, the results of the screening in individual groups of the population of Russia for antibodies to HIV, carried out at the period of 1994 to the first half of 1999, are presented. In 1999 a considerable rise in the number of newly detected cases of HIV infection, mainly among persons injecting psychotropic drugs intravenously for non-medical purposes, was noted. The conclusion was made that the spread of HIV among drug addicts led to its passage to other groups of the population, mainly by heterosexual transmission.     

The prevention of HIV infection and other blood-contact diseases among intravenous narcotic users in Nizhniy Novgorod within the framework of the Harm Reduction program

The results of the development and realization principles of the project on the decrease of harm, envisaging work in three directions (the determination of the technology of using drugs, the exchange of syringes/needles and other accessories, as well as laboratory examination for the presence of antibodies to HIV, hepatitis B and hepatitis C viruses and consultations of narcologists). 1075 injecting drug users took part in this project. Out of 611 participants filling-in the questionnaires, 338 persons underwent tests for HIV and 3 of them were found to be HIV-infected; out of 305 persons screened for the presence of markers of hepatitis B virus, positive results were obtained in 98 (32% of cases); in 218 (65%) out of 335 persons antibodies to hepatitis C virus were found (49 persons, i.e. 14%, had hepatitis C registered in the medical history and in the rest antibodies were detected for the first time). The preventive program of the decrease of harm was assessed as effective.     

The prevalence of the use of narcotics and other psychoactive substances in Russia today

The epidemiological analysis of morbidity in drug addiction in Russia for the period of 25 years is presented. As shown in this analysis, by 1992 the number of drug addicts rose twofold in comparison with 1986, and by 1998 this number rose tenfold, reaching 109.5 per 100,000 of the population. The total number of persons given medical assistance on account of the abuse of narcotic and non-narcotic substances exceeded 295,000. The analysis states that the ratio of persons having problems with drugs and applying for medical assistance to the actual number of drug addicts is 1:7, i.e. the number of drug addicts among the population exceeds 2 million persons. The spread of drug addiction among adolescents, which grew eightfold during the last 10 years, is a particularly unfavorable phenomenon. The established tendencies towards the growth of morbidity rates in individual groups of population in Russia and the data obtained by questioning among the population are indicative of growth in the spread of drug addiction. This regularity is confirmed by the growing proportion of children, adolescents and women among those who applied for medical assistance for the first time.     

The use of bacterial interference to prevent infection

For decades, bacterial strains of low virulence were occasionally used in man to replace or to block colonization by the more virulent organisms and thereby prevent bacterial infection. This paper reviews the topic and presents recent information on the implantation of strain 215 alpha-hemolytic streptococcus (alpha-strep) in the nasopharynx of neonates in the intensive care unit. A single inoculation of strain 215 can change abnormal colonization of the pharynx to "normal" (alpha-strep predominant) in 48-72 h in most neonates. Following implantation, alpha-strep with strain 215 like characteristics fluctuate among naturally occurring strains of alpha-strep, sometimes persisting in dominance and sometimes decreasing rapidly as new strains appear. Strain 215 can survive in the pharynx during subsequent antibiotic therapy and can be recalled to dominance by such therapy. It seems remarkably stable in vivo. There is no evidence of its nosocomial spread in the nursery. Streptococcus with strain 215 like characteristics occurred naturally in 1-6% of neonates in our intensive care unit. No infection (disease) attributable to strain 215 occurred in implanted infants.     

The behavioral risk factors for contracting HIV infection in the intravenous administration of narcotics in abusers of psychoactive substances in the city of Rostov-on-Don

150 persons (drug users) who had applied to the department of psycho-social consultations and voluntary tests for the presence of HIV infection and STD of the Regional AIDS Control Center, as well as partners of HIV-infected addicts in the intravenous use of drugs, were examined. Out of 150 examined persons 63 were found to be positive for HIV infection. Among dangerous behavioral patterns, characteristic of drug addicts introducing drugs intravenously, the practice of repeated aspiration of the drug into syringes from the dose of the drug solution, common for the whole group of addicts, was noted as the most widespread habit.     

The prevalence of hepatitis B and C markers among narcotic users

611 patients with acute parenteral virus hepatitis (VH) were studied with a view to find out markers indicating the presence of hepatitis B and hepatitis C virus infection (HB, HC, HB + C, HC + HBsAg). Of these, 166 patients (27.2%) systematically used narcotic drugs intravenously. Essential differences between drug users and VH patients without drug addiction were established regarding the distribution of patients by age and sex, the etiological structure and severity of the disease. Thus, in the group of drug users the prevalence of males, young people (15-29 years of age) and the mixed form of hepatitis B + C was noted. In VH patients using drug the disease took a more severe course than in such patients without drug addiction. The highest proportion of intravenously drug users with a severe and moderate course of the disease was found among patients with HB + C and HB.     

The introduction of projects to prevent HIV infection among people using injection narcotics and women in the sex business in the city of Simferopol'

The work on the realization of the Project on the Prevention of HIV infection, carried out by the Charity Fund "Hope and Salvation" in 1998-1999 in the Crimea is described. As shown by the analysis of the results of behavioral reactions, the forms of behavior used by drug-dependent persons contribute to the spread of HIV infection. Since November 1999 the realization of the pilot project on the reduction of HIV infection among injecting drug users has been started in Simferopol (with the financial support to the Pasteur Institute and the advisory support of the UN Representation in the Ukraine). The necessity of the development of the Project "Decrease of Spread of HIV and Sexually Transmitted Diseases among Female Sex Workers in Simferopol" is substantiated.     

The possible role of immunogenetic factors in the pathogenesis of HIV infection

In this review the data on the presence of associations between immunogenetic markers and the development of HIV infection are presented. Special attention is given to spatial relationships of genetic determinants, responsible for the synthesis of the components of the complement system on one hand and the genes controlling resistance to the causative agents of opportunistic infections and malignant growth on the other hand. Suggestion is made on close relationship between the specific features of the course of HIV infection and the genetic control, responsible for the synthesis of complement components, in particular the genes making up the HLA system.     

The prevention of HIV/AIDS among injection narcotics users in the city of Odessa

Since August 1996 the realization of the first Ukrainian Project "HIV/AIDS Preventive Maintenance among Injecting Drug Users", based on the strategy of harm reduction, has been started in Odessa with a view to the effective counteraction to the spread of HIV/AIDS among injecting drug users (IDU). The project is being realized with the advisory and financial support of UNAIDS, UNICEF and USAID. The basic organization for the realization of the Project is the Public Movement "Faith, Hope, Love". The Project is aimed at decreasing the rate of the spread of HIV infection in cases of the non-medical use of narcotic drugs by the elaboration and adoption of measures conductive to changes in hazardous behavior. The realization of the project includes the following stages: the rapid evaluation of the situation with the injecting use of drugs in Odessa, the elaboration and adoption of preventive measures.     

Mechanisms of immunodeficiency in HIV infection and ways of overcoming it]

Though antibodies against HIV-1 appearing in the course of infection are successfully used for the diagnostic purposes, their accumulation on the earlier step leads to: firstly, to the rapid generation of the immunodeficiency by different mechanisms and secondly, to inefficiency of immunotherapy. One of the causes for immunodeficiency seems to be antibodies which are induced in the HIV-infected person by the HIV peptides homologous to the MHC class II molecules by their amino acid sequences. 73% of HIV-1 positive sera are shown to react with human B-lymphoma cells expressing surface class II molecule. The binding is caused by the antibodies preventing the murine monoclonal anti-HLA.DR Ab interaction with B-lymphoma. Three amino acid sequences are identified in both alpha- and beta-chain of the HLA.DR antigen, these sequences being homologous to HIV-1 gp120 or gp42 molecules for 50 to 70%. Using synthetic peptides it was shown that HIV-1-infected persons contain antibodies which cross-react to the homologous peptides of the HIV-1 and of the MHC class II. It is supposed that such antibodies shield the class II molecule on the surface of their own antigen-presenting cell which may lead to immunodeficiency caused by the anti-HIV-1 antibody.     

The effect of a syringe-exchange program on a decrease in the risk of HIV infection among intravenous narcotic abusers in the city of Rostov-on-Don

The necessity and effectiveness of introducing the program of the exchange of syringes for intravenous drug users as a preventive and antiepidemic measure are discussed. Preventive and antiepidemic measures within the concept of harm reduction are described. The comparative analysis of materials obtained as a result of two sociological questionings, carried out in 1997-1998 among the representatives of the community (random nonrepeating choice) and in the middle of 1999 among the participants of the program revealed that the participants of the program had statistically significant changes in risky behavior patterns during the use of injection drugs.     

The HIV infection epidemic in the city of Irkutsk under the conditions of drug abuse prevalence

The data on the spread of HIV infection in Irkutsk and Irkutsk Province, starting from March 9, 1999, are presented. The simultaneous appearance of 17 multiple morbidity foci of HIV infection, involving 2,227 persons into the epidemic, within the period of 8 months was noted. The age structure of the epidemic process was represented by 1,846 adults aged 18-50 years (83%), 256 adolescents aged 16-17 years (12.9%), 78 children aged 10-15 years (3.5%) and 17 persons of other ages (0.53%). The leading role in the age structure of the epidemic process belonged to young people aged 10-29 years (90.4% of cases). The epidemiological analysis made it possible to establish the fact that the epidemic was linked with the intravenous injection of heroin. The viral contamination of the drug is not excluded also in the process of its preparation for injection.     

Mutational analysis of the CCR5 and CXCR4 genes (HIV-1 co-receptors) in resistance to HIV-1 infection and AIDS development among intravenous drug users

We analysed a group of Spanish intravenous drug users and controls to determine the role of mutations at the chemokine receptor-5/HIV-1 cofactor (CCR5), previously implicated in resistance to HIV-1 infection, and CXCR4 genes in susceptibility to HIV-1 infection. The complete coding sequence of both genes was amplified by the polymerase chain reaction from genomic DNA of 50 seropositive slow progressors and 10 long-term non-progressors, and analysed by the single-strand conformation polymorphism technique in a search for mutations. No mutation in CXCR4 was found, and Δccr5 was the only mutation identified at the CCR5 gene. We genotyped (Δccr5 allele) 150 HIV-1+ intravenous drug users and 250 healthy controls from the same population (Asturias, Northern Spain). Patients were divided into rapid progressors, presenting an event indicating progression to the acquired immunodeficiency syndrome (AIDS) in the 2 years after infection (100 patients), and slow progressors, remaining asymptomatic for 2–10 years (50 patients). The frequencies of the Δccr5 allele were 0.105 and 0.040 in controls and HIV-1+ patients, respectively. Eighteen per cent of the controls (45/250) and 8% (12/150) of the patients carried the Δccr-5 allele (P=0.013). The frequency of Δccr5 carriers among rapid and slow disease progressors was 3 and 15%, respectively. A highly significant difference was found between rapid progressors and controls (P=0.0014). No patient (0/150) was Δccr5 homozygous compared with 1% among controls. Thus, the Δccr5 allele (the only CCR5 mutation found in our HIV-1 patients) was rare among seropositive intravenous drug users, suggesting that the absence of this mutation confers an advantage to the virus when infecting cells in vivo. In addition, patients carrying the Δccr5 allele tend to show a slow progression towards HIV-1-related disease, remaining asymptomatic for longer periods of time. Received: 15 October 1997 / Accepted: 12 January 1998     

The forms and analysis of the results of work in preventing HIV infection among youth

Specialists of the AIDS Centre distributed questionnaires, specially developed by them, among a group of students of the Pedagogical University. The questionnaire contained 35 questions; of these, 21 questions were intended to find out what information on HIV infection and AIDS the students had and 14 questions dealt with their sexual history and their attitude to the problem. The answers to the questionnaires distributed among 100 students (68% were females and 32% were males) showed that 58% of the respondents had previous sexual experience. 68.5% of the respondents had sexual intercourse after taking alcohol, 7.4% always used condoms, 38.8% seldom and 53.7% never used condoms. The behavior of 68.8% of the respondents was not influenced by information on HIV infection they received, 16% reduced the number of casual sexual partners, 8.6% started using condoms, 6.5% reduced the number of sexual partners.     

The protective activity of 2 normal immunoglobulin preparations for intravenous administration in experimental Pseudomonas aeruginosa infection

The antibody levels in 18 batches of the preparations of human immunoglobulin, Immunovenin and Immunovenin-Intact, for intravenous injection were determined in the enzyme immunoassay with the use of the mixture of P. aeruginosa lipopolysaccharide antigens of seven immunotypes. The average antibody titers in these preparations were identical. The preparations were found to have protective action against P. aeruginosa experimental infection in mice.     

The prevention of HIV infection and STDs among injection drug addicts in Ukraine

In 1996-1998 joint pilot Projects of the National Committee and the UNAIDS Program were carried out in 10 Ukrainian cities. The behavior determinants contributing to the spread of HIV infection, common for all regions under study, were determined. They were linked with the injections of narcotic drugs, sexual behavior and the level of knowledge on the infection. The effectiveness of the projects was due to the 80% coverage of those drug addicts who could not be reached by common narcotic drug services; to the use of individual syringes (increased from 43% to 95%); to a decrease in the sale of ready-made drugs in used syringes to 14%; to an increase in the index of the return of used syringes; to an increase in the proportion of persons constantly using condoms (58%); etc. Still the situation was found to give no grounds for optimism, and the conclusion was made that the strategy of "decreasing the harm" must become the policy and strategy of the public health system.     

The use of the indirect hemagglutination reaction for the serodiagnosis of HIV infection

An assay system, based on the passive hemagglutination test and permitting the serodiagnosis of HIV infection with correct results in more than 99% of cases, has been developed. Three kinds of freeze-dried erythrocyte diagnostica (with shelf life exceeding 6 months), possessing high serological activity and sensitized with recombinant gene-engineering polypeptides, have been obtained. The proposed assay system is highly promising for mass examination of sera for the presence of antibodies to HIV due to the simplicity of assay techniques, the possibility of storing the diagnostica within a wide range of temperatures (4 degrees-30 degrees C) and obtaining results in a short time (3 hours).