The Effects of live- in rehabilitation on ARV adherence, abstinence from drugs and lifestyle modification in people who inject drugs (PWID) Living with HIV – A clinic review

Background & Objective: HIV/AIDS is mostly seen in people who inject recreational drugs (PWID). Adherence has to be optimum for its treatment to be effective. Compliance to HIV medication has been problematic in PWID making HIV control difficult. Many studies in the past have validated educational activities like rehabilitation programs beneficial in maintaining regularity in medication intake. This brought us to the question of looking at such programs and its effects on our population. This study was conducted to assess the impact of other perspectives of abstinence and adherence including family support and employment status on a person’s willingness for treatment continuation and avoidance of drugs. Methods: A retrospective chart review of 241 PWID was conducted to assess adherence to antiretroviral agents (ARVs) and abstinence from recreational drugs post visit to the rehabilitation center. Associations with family support, marital status, employment, income and back to work status were also assessed. Results: Adherence to ARVs had significant statistical association with marital status (p=0.025), starting work again (p=0.001), family support (p=0.009), employment status (p=0.009) and monthly income (p=0.025). While family support (p=0.033), employment status (p<0.0001), Going back to work (p<0.0001), mode of travel to Rehabilitation center (p<0.0001) and monthly income (p=0.004) were associated with abstinence from drugs. Duration of rehabilitation or age had no effect on adherence or abstinence in our patient population of PWID. Conclusion: Family and spousal support and employment promote optimal ARV compliance and should be encouraged when starting ARVs. Enrollment in a long-term complementing educational program would further enhance ARV intake and abstinence. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5780 How to cite this:Hussain A, Rahim A, Sheikh A, Jiwani A. The Effects of live- in rehabilitation on ARV adherence, abstinence from drugs and lifestyle modification in people who inject drugs (PWID) Living with HIV – A clinic review. Pak J Med Sci. 2022;38(2):411-416. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5780 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

2C-x and DOx hallucinogens: a systematic review

The drug market has seen a significant global expansion in the last decades. The synthetic designer drugs belonging to the class of amphetamines and derived phenylethylamines have experienced the greatest spread in the drug market for abuse. As phenylethylamines are organic compounds that stimulate the central nervous system of humans, many are abused as recreational drugs. A large array of substituted amphetamines can be easily synthetized by replacing one or more hydrogen atoms in the structure of phenylethylamine. Among these, the most dangerous for human health are those analogues or homologues that have hallucinogenic effects (besides the stimulant pharmacological activity), such as those belonging to the 2C-x and DOx classes of amphetamines. This review describes the physico-chemical and spectral properties of the most representative compounds of the two classes.

Design, Synthesis, And Evaluation of Functionalized Diamino-butylbenzamides As Selective Dopamine D3 Receptor Ligands

Substance use disorder remains a major, unmet medical need. Cocaine is one of the most commonly abused recreational drugs and in 2018, there were over 5.5 million current cocaine users. There are no approved therapies for the treatment of cocaine use disorder, but the D3 dopamine receptor has been identified as a potential therapeutic target. We have identified a series of functionalized diamino-butylbenzamides that are potent D3 binders with moderate to high selectivity for D3 over D2.

Risk factors for HIV infection among men who have sex with men in the ANRS IPERGAY PrEP trial

ObjectivesWe aimed to assess among men who have sex with men (MSM) risk factors for HIV infection, to identify those who require urgent pre-exposure prophylaxis (PrEP) prescription.MethodsAll participants enrolled in the placebo arm of the ANRS IPERGAY trial, or infected between screening and day 0, were included. Baseline characteristics were described and HIV incidence rate ratios (RRs) were estimated with their 95% CIs.Results203 MSM were included with a median follow-up of 9 months. During the study period, 16 participants acquired HIV infection while not receiving tenofovir disoproxil and emtricitabin (TDF/FTC) over 212.4 person-years (PYs) of follow-up (incidence rate 7.5/100 PYs, 95% CI: 4.3 to 12.2). Being enrolled in Paris was associated with a significant increased risk of HIV infection (RR: 4.1; 95% CI: 1.1 to 28.3). A high number of sexual partners in prior 2 months (≥10 vs <5) and of condomless receptive anal sex episodes in prior 12 months (>5 vs <5) were strong predictors for HIV acquisition (RR: 10.6 (2 to 260.2) and 3.3 (1.2 to 10.2), respectively). Those who reported more often or only receptive sexual practices were also at increased risk (RR: 9.8 (2.0 to 246.6)). The use of recreational drugs in prior 12 months, especially gamma hydroxybutarate/gamma butyrolactone (RR: 5.9; 95% CI: 2 to 21.7), was associated with a significantly increased risk of HIV acquisition even after adjustment for sexual practices.ConclusionsMSM who have frequent condomless receptive anal sex and multiple partners, or use recreational drugs should be targeted in priority for PrEP prescription especially if they live in an area with a high prevalence of HIV infection.

Evaluation of treatment response and symptom progression in 400 patients with visual snow syndrome

AimsTo gather information on useful medications to treat visual snow syndrome (VSS) as well as to validate an instrument to assess its clinical severity and the course of the disorder over time.MethodsFour hundred patients with VSS were included in this web-based prospective questionnaire study. All subjects completed a treatment questionnaire and a clinical diary. The first allowed evaluation of the effects of previous medications on visual snow, while the second measured VSS symptoms daily over the course of 30 days.ResultsPatients commonly reported previous use of medications such as antidepressants, antiepileptics, antibiotics and benzodiazepines. However, none of these drug classes was beneficial for the majority of patients. Recreational drugs and alcohol worsened visual snow symptoms in several reports. Vitamins and benzodiazepines had high therapeutic ratios, although in most cases they did not change the course of VSS.The monthly diary confirmed that the static in VSS is a consistent symptom over time. It also showed that indoor and fluorescent lights have a worse effect on symptoms when compared with natural outdoor lighting.ConclusionsThe study confirms clinical experience that medications are generally ineffective in VSS, with the exception of vitamins and perhaps benzodiazepines, which could be beneficial in some patients. The 30-day diary represents a useful tool to measure symptom progression over time, which could be used in future trials on VSS.

Sex, Drugs, and Genes: Illuminating the Moral Condemnation of Recreational Drugs

Over the past decade, evolutionary psychologists have proposed that many moral stances function to promote self-interests. At the same time, behavioral geneticists have demonstrated that many moral stances have genetic bases. We integrated these perspectives by examining how moral condemnation of recreational drug use relates to sexual strategy (i.e., being more vs. less open to sex outside of a committed relationship) in a sample of Finnish twins and siblings ( N = 8,118). Twin modeling suggested that genetic factors accounted for 53%, 46%, and 41% of the variance in drug condemnation, sociosexuality, and sexual-disgust sensitivity, respectively. Further, approximately 75% of the phenotypic covariance between drug condemnation and sexual strategy was accounted for by genes, and there was substantial overlap in the genetic effects underlying both drug condemnation and sexual strategy ( rg = .41). Results are consistent with the proposal that some moral sentiments are calibrated to promote strategic sexual interests, which arise partially via genetic factors.

Health-Related Quality Of Life And Its Determinants Among Recreational Drug Users In A Rural Area In Cameroon: A Cross-Sectional Study

Background This study was aimed to evaluate the health-related quality of life (HRQoL) and its drivers among recreational drug users, compared to non-users using WHOQOL-BREF. Methods A total of 246 recreational drug users and 141 non-recreational drug users were recruited using consecutive sampling of adults in the community. Socio-demographic data, data related to recreational drug use and HRQoL were collected. Data were compared using t-test, analysis of variance and chi-square test. Determinants of HRQoL were obtained using multivariate regression models. Results The mean overall quality of life (OQOL) score was significantly higher for non-recreational drug users compared to users (75.89 ± 22.64 vs 61.08 ± 23.94, respectively, p < 0.001), non-users as well had significantly higher mean scores across all four domains of WHOQOL-BREF. After multivariable adjustment, use of recreational drugs negatively affected the psychological domain (β=-4.17, 95% CI -8.22 to -0,13) and the environmental domain (β=-4.47, 95% CI -8.48 to -0.45). Years of recreational drug use affected the social relationship domain (β=-0.55, 95% CI -0.88 to -0.22), OQOL (β=-0.57, 95% CI -0.94 to -0.19), and general health satisfaction (β=-0.71, 95% CI -1.08 to -0.35). Number of recreational drugs used contributed to poorer physical health (β=-1.45, 95% CI -2.57 to -0.33), psychological domain (β=-2.04, 95% CI -3.18 to -0.91), social relationship domain (β=-1.87, 95% CI -3.39 to -0.35) as well as overall quality of life (β=-2.13, 95% CI -3.89 to -0.37). Besides recreational drugs, monthly income also affected physical health (β = 5.17, 95% CI 2.96 to 7.38), psychological domain (β = 3.34, 95% CI 1.10 to 5.58), environmental domain (β = 2.64, 95% CI 0.42 to 4.85) and also the OQOL (β = 4.16, 95% CI 0.70 to 7.62). Conclusions Our findings suggest that, recreational drugs significantly negatively affect the health-related quality of life of its users. People who use multiple recreational drugs and longer years of recreational drug use had a more widespread effect across the health domains. Higher monthly income could improve the HRQoL of recreational drug users.

Pneumomediastinum in a cannabis smoker precipitated by vigorous sexual intercourse

Primary pneumomediastinum is the presence of air in the interstitium of the mediastinum. The exact aetiology is unclear; nevertheless, it has been reported more frequently in patients with asthma and in individuals who use recreational drugs. It is commonly preceded by a sharp rise in intrathoracic pressure as in a Valsalva-like manoeuvre. We describe a rare case of severe pneumomediastinum with a small pneumothorax related to cannabis smoking and aggravated by vigorous sexual intercourse. The patient was successfully treated conservatively due to clinical and radiological stability and the absence of secondary cause.

From the Farm to the Lab: How Chicken Embryos Contribute to the Field of Teratology

Congenital anomalies and its causes, particularly, by external factors are the aim of the field called teratology. The external factors studied by teratology are known as teratogens and can be biological or environmental factors for example, chemicals, medications, recreational drugs, environmental pollutants, physical agents (e.g., X-rays and maternal hyperthermia) and maternal metabolic conditions. Proving the teratogenicity of a factor is a difficult task requiring epidemiology studies as well as experimental teratology evidence from the use of animal models, one of which is the chicken embryo. This model in particular has the advantage of being able to follow development live and in vivo, with rapid development hatching around 21 days, is cheap and easy to manipulate and to observe development. All this allows the chicken embryo to be used in drug screening studies, teratogenic evaluation and studies of mechanisms of teratogenicity. The chicken embryo shares morphological, biochemical and genetic similarities with humans as well as mammalian species, making them ideal to ascertain the actions of teratogens, as well as screen drugs to test for their safety. Pre-clinical trials for new drugs are carried out in rodents and rabbits, however, chicken embryos have been used to screen new compounds or analogs of thalidomide as well as to investigate how some drugs can lead to congenital malformations. Indeed, the chicken embryo has proved valuable in understanding how many congenital anomalies, seen in humans, arise following teratogen exposure. The aim of this review is to highlight the role of the chicken embryo as an experimental model for studies in teratology, exploring its use in drug screening studies, phenotypic evaluation and studies of teratogenic mechanisms of action. Here, we discuss many known teratogens, that have been evaluated using the chicken embryo model including some medicines, such as, thalidomide, valproic acid; recreational drugs including alcohol; environmental influences, such as viruses, specifically ZIKV, which is a newly discovered human teratogen. In addition, we discuss how the chicken embryo has provided insight on the mechanisms of teratogenesis of many compounds and also how this impact on drug safety.

Does the Presence of On-Site Medical Services at Outdoor Music Festivals Affect Attendees’ Planned Alcohol and Recreational Drug Use?

Background: Dedicated on-site medical services have long been recommended to improve health outcomes at mass-gathering events (MGEs). In many countries, they are being reviewed as a mandatory requirement. While it is known that perceptions of risk shape substance use plans amongst outdoor music festival (OMF) attendees, it is unclear if attendees perceive the presence of on-site medical services as a part of the safety net. The aim of this paper is to better understand whether attendees’ perceptions of on-site medical services influence high-risk behaviors like alcohol and recreational drug use at OMFs. Method: A questionnaire was distributed to a random sample of attendees entering and attending two separate 20,000-person OMFs; one in Canada (Festival A) and one in New Zealand (Festival B). Responses focused on demographics, planned alcohol and recreational drug use, perceptions of medical services, and whether the absence of medical services would impact attendees’ planned substance use. Results: A total of 851 (587 and 264 attendees for Festival A and Festival B, respectively) attendees consented and participated. Gender distribution was equal and average ages were 23 to 25. At Festival A, 48% and 89% planned to use alcohol and recreational drugs, respectively, whereas at Festival B, it was 92% and 44%. A great majority were aware and supportive of the presence of medical services at both festivals, and a moderate number considered them a factor in attendance and something they would not attend without. There was significant (>10%) agreement (range 11%-46%; or 2,200-9,200 attendees for a 20,000-person festival) at both festivals that the absence of medical services would affect attendees’ planned use of alcohol and recreational drugs. Conclusions: This study found that attendees surveyed at two geographically and musically distinct OMFs had high but differing rates of planned alcohol and recreational drug use, and that the presence of on-site medical services may impact attendees’ perceptions of substance use risk. Future research will aim to address the limitations of this study to clarify these findings and their implications.