Drug Abuse and HIV/AIDS

Research Findings from February, 1999 Director's Report

This section lists selected summaries from NIDA funded research projects that investigate youth drug abuse and HIV/AIDS. The summaries provided were selected from recent issues of the Director's Report to the National Advisory Council on Drug Abuse. For a more comprehensive listing of NIDA funded projects see the Director's Report.

Increased Transmission of Vertical Hepatitis C Virus (HCV) Infection to Human Immunodeficiency Virus (HIV) Infected Infants of HIV and HCV Co-infected Women

The transmission of perinatal HCV infection was studied retrospectively in infants born to HCV and HIV co-infected women enrolled in a prospective natural history study of HIV transmission. Infant HCV infection was assessed by RNA PCR. The overall rate of vertical HCV transmission was 16.4% (9/62). The rate of HCV infection was higher among HIV-infected infants than among HIV-uninfected infants (40% vs.5%; OR, 8.2; p=.009). This difference in transmission was not related to maternal HCV viral load by branched DNA assay, or mode of delivery. The rate of HCV transmission in HIV-uninfected infants of HIV and HCV co-infected mothers was similar to that reported for infants born to HIV-uninfected mothers. Papaevangelou, V., Pollack, H., Rochford, G., Kokka, R., Hou, Z., Chernoff, D., Hanna, Krazinski, K., Borkowsky, W. J Infect Dis., 178, pp.1047-52, 1998.

Sex Differences in HIV-1 Viral Load and Progression to AIDS

A study of HIV-1 viral load differences in men and women was performed in an ongoing cohort study of injection drug users. Women were found to have significantly lower viral load measurements than men. HIV-1 was measured by branched chain DNA at baseline, and by reverse-transcriptase PCR and quantitative microculture on follow-up three years later. Median viral load measurements were significantly lower in women than men by all three methods. Viral load measurements in women were 38- 65% of those in men. The association of lower viral load in women remained even after adjusting for CD4 cell count, race, and drug use. While men and women had statistically similar time to AIDS, women with the same viral load as men had a 1.6-fold higher risk of AIDS, or, equivalently, women with half the viral load of men had a similar time to AIDS. These results suggest that, while men and women have similar time to AIDS, there is a different relationship between viral load and AIDS in women compared to men. While a biological mechanism remains to be elucidated, these findings have implications for timing of initiation of therapy relative to viral load thresholds in women. Farzadegan, H., Hoover, D., Astemborski, J., Lyles, C.M., Margolick, J.B., Markham, R.B., Quinn, T.C. Lancet, 352, pp.1510-1514, 1998.

HIV Risk among African-American Youth

Ramirez-Valles and colleagues examined the community and personal risk factors for HIV infection among a predominantly African-American sample of teenagers at risk for drug abuse. Sexual activity among high-school-aged youths has steadily increased since the 1970s, emerging as a significant public health concern. Yet, patterns of youth sexual risk behavior are shaped by social class, race, and gender. Based on sociological theories of financial deprivation and collective socialization, the authors developed and tested a model of the relationships among neighborhood poverty; family structure and social class position; parental involvement; prosocial activities; race; and gender as they predict youth sexual risk behavior. Structural equation modeling was used to test this model on a cross-sectional sample of 370 sexually active high-school students from a midwestern city; 57 percent (n = 209) are males and 86 percent are African American. Family structure was found to indirectly predict sexual risk behavior through neighborhood poverty, parental involvement, and prosocial activities. In addition, family class position indirectly predicts sexual risk behavior through neighborhood poverty and prosocial activities. Ramirez-Valles, J., Zimmerman, M.A., and Newcomb, M.D. Sexual Risk Behavior among Youth: Modeling the Influence of Prosocial Activities and Socioeconomic Factors. Journal of Health & Social Behavior, 3, pp. 237-253, 1998.

Stages of Adaptation and Negotiating Behavioral Change in HIV+ Adolescent Girls

A demonstrative case of an HIV-positive girl is presented in order to illustrate the stages of adaptation that HIV positive youth undergo (i.e., acceptance, resumption of life, coping with reminders of serostatus). Also discussed is the process by which this individual changes her behavior (e.g., reduction in transmission behaviors, adherence to medical programs, improving quality of life) and the integral role and contributions the service provider can make in the behavioral-change process for HIV-positive youth. Finally, this case illustrates some of the unique issues encountered by HIV-positive women and how those issues can be incorporated into a comprehensive, coordinated, and continuous system of care through an intervention such as Teen Linked through Care (TLC). Lightfoot, M. and Rotheram-Borus, M.J. Negotiating Behavior Change with HIV-Positive Adolescent Girls. AIDS Patient Care, 12(5), pp. 395-401, 1998.