The human immunodeficiency virus, also known as HIV infection, is a retrovirus that causes AIDS (acquired immune deficiency syndrome). The retrovirus primarily attacks the body's immune system, making the body extremely vulnerable to opportunistic infections (infections that occur in immunocompromised individuals).
HIV is transmitted from person to person via bodily fluids, including blood, semen, vaginal discharge and breast milk. It can be spread by sexual contact with an infected person, by sharing needles/syringes with someone who is infected, or, less commonly (and rare in countries where blood is screened for HIV antibodies), through transfusions with infected blood. HIV has been found in saliva and tears in very low quantities and concentrations in some AIDS patients. However, contact with saliva, tears, or sweat has never been shown to result in transmission of HIV.
Since the AIDS epidemic began, injection drug use (IDU) has directly and indirectly accounted for more than one-third of AIDS cases in the United States. In the year 2000, out of the 42,156 new cases of AIDS reported 11,635 were IDU-associated.
Injection drug use is more common among racial and ethnic minorities in the United States, which makes them more likely to acquire HIV through IDU. In 2000, IDU accounted for 26% of all AIDS cases among African American adults and 31% among Hispanic adults and adolescents, compared to 19% of all cases among white adults and adolescents
In addition, women are more likely than men to acquire HIV through IDU. Fifty-seven percent of all AIDS cases reported among women have been attributed to injection drug use or sex with partners who inject drugs, compared to 31% of cases among men.
The use of non-injection drugs also contributes to the spread of HIV. Drug users typically engage in riskier behaviors than non-drug users. For instance, users may trade sex for drugs or money, or they may engage in behaviors that put them at risk for developing the infection while under the influence of drugs.
Currently, there is no cure for HIV infection or AIDS. Highly active antiretroviral therapy (HAART) can suppress the virus, even to undetectable levels, but the medications cannot completely eliminate HIV/AIDS.
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Drug addiction is considered a treatable disease. Addiction causes compulsive drug cravings, and addicts will continue to seek the drug, even in the face of severe adverse consequences. For many people, drug addiction is chronic, and it may last for years.
Relapses are possible, even after long periods of abstinence from the drug. As a chronic, recurring illness, addiction may require repeated treatments to increase the intervals between relapses until long-term abstinence is achieved.
Rehabilitation treatment programs are tailored to each individual's specific needs. People with drug addictions can achieve full recovery and lead healthy, productive lives.
injection drug use
Many drugs, including cocaine and heroin, can be injected directly into the bloodstream. Injection drug users (IDUs) may become infected with HIV, hepatitis C and other infectious diseases after sharing syringes and injection paraphernalia that have been used by infected individuals.
In 2003, exposure to injection drugs was responsible for 20% of new AIDS cases reported in men in the United States. In the same year, 5.9% of new AIDS cases resulted from sexual contact with men who had sex with men and injected drugs. Twenty-two percent of all men living with AIDS in the end of 2003 acquired the disease through IDU. The rate was higher, (30%) among African American and Hispanic males.
In 2003, exposure to injection drugs was responsible for 26.9% of new AIDS cases in women in the United States. At the end of 2003, it was estimated that 35% of all women living with AIDS acquired the disease from exposure to injection drugs or injection drug users. The rate was higher among American Indian/Alaskan Native women (41%) and Whites (40%). The rates were lower among female African Americans and Hispanics (33%) and Asian/Pacific Islanders (16%).
From 1998 (when HAART became widely available) to 2003, AIDS mortality among people who acquired the disease from IDU declined an average of seven percent. However, the rate increased 4.4% among women alone.
non-injection drug use
Risky behavior: The use of non-injection drugs also contributes to the spread of HIV. Drug users typically engage in riskier behaviors than non-drug users. For instance, users may trade sex for drugs or money, or they may engage in behaviors that put them at risk for developing the infection while under the influence of drugs.
Recent studies suggest that trauma, substance abuse and sexual risk behaviors are all related. For instance, women who have experienced sexual abuse (as a child or as an adult) may have a hard time refusing unwanted sex, may use drugs as a coping mechanism or may engage in sexual activities with strangers more frequently than other women. According to research, past trauma may also cause women to be less assertive with birth control (including condoms), and they may have a greater number of sexual partners during their lifetime, which increases the risk for HIV.
Biological impact: Researchers have found that both methamphetamine abuse and HIV infection can cause impaired cognitive (mental) functions. Patients may experience difficulties learning new information, solving problems, concentrating and quickly processing information. The researchers suggest that methamphetamine abuse and HIV infection significantly reduce the size of certain brain structures, which may be associated with impaired cognitive functions. Co-occurring methamphetamine abuse and HIV infection has shown to cause a greater impairment than each condition alone.
Alcohol: Alcohol abuse appears to be prevalent among HIV patients. One study found that 41% of HIV-infected patients met the criteria for alcoholism, as defined by a score of five or higher on the Michigan Alcoholism Screening Test (MAST) survey.
Recent studies have shown that HIV-infected patients with a history of alcohol problems, who are receiving HAART and are currently drinking, have greater HIV progression than those who do not drink.
In addition, one animal study found that alcohol consumption might increase an individual's risk of developing HIV. The researchers studied rhesus monkeys that were infected with simian immunodeficiency virus (SIV). Alcohol was administered four consecutive days a week by an intragastric catheter, until an alcohol concentration of 50-60mM was reached. The researchers found that during the early stages of infection, the monkeys who received alcohol had 64 times the amount of virus in their blood than the control monkeys. The researchers concluded that the alcohol either increased infectivity of cells or increased the number of susceptible cells.
Also, several studies suggest that HIV/AIDS patients who drink, especially those who drink heavily, are less likely to adhere to treatment regimens. Researchers have found that up to half of HIV/AIDS patients who drank heavily reported taking antiretroviral medication off schedule. Taking antiretrovirals off schedule may allow HIV to replicate more rapidly, causing increased mutations in the virus. When HIV mutates, it may become resistant to treatment.