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BRIEF RESEARCH ARTICLE
Year : 2022  |  Volume : 66  |  Issue : 3  |  Page : 331-333  

Exploring the clinical variables among drug-dependent HIV-Positive patients: Implications for treatment strategies


1 Additional Professor, Department of Psychiatry, National Drug Dependence Treatment Center, All India Institute of Medical Sciences, New Delhi, India
2 Assistant Professor, Department of Psychiatry, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
3 Professor, Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India

Date of Submission06-Jun-2021
Date of Decision29-Jul-2022
Date of Acceptance29-Jul-2022
Date of Web Publication22-Sep-2022

Correspondence Address:
Rizwana Quraishi
Department of Psychiatry, National Drug Dependence Treatment Center, All India Institute of Medical Sciences, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijph.ijph_1317_21

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   Abstract 


This study explored the profile of HIV positive patients seeking treatment at a tertiary care addiction treatment facility. A retrospective study was done to collet detailed information on clinical characteristics: drug use (type, age of initiation, duration), general medical condition and past treatment history. The study included 138 patients with mean (SD) age 30.2 (8.3) years. Opioid dependence with injecting drug use (IDU) was diagnosed in 97% of the patients. The median age of injecting onset was 24.5 years (IQR 20-31 years). The most frequently injected substances were pheniramine (60.1%) and buprenorphine (59.4%). Past treatment seeking was reported by 57% patients and interestingly they were less likely to present any medical condition (2 =69.611, p < 0.001). Variability in the age of onset of drug use indicates the need for broad based approach to prevent IDU and motivation to seek treatment may lead to better health conditions.

Keywords:  High-risk sexual behaviors, human immunodeficiency virus, injecting drug use, substance use disorder, treatment seeking


How to cite this article:
Quraishi R, Sarkar S, Parmar A, Jain R, Das BK, Ambekar A. Exploring the clinical variables among drug-dependent HIV-Positive patients: Implications for treatment strategies. Indian J Public Health 2022;66:331-3

How to cite this URL:
Quraishi R, Sarkar S, Parmar A, Jain R, Das BK, Ambekar A. Exploring the clinical variables among drug-dependent HIV-Positive patients: Implications for treatment strategies. Indian J Public Health [serial online] 2022 [cited 2022 Nov 26];66:331-3. Available from: https://www.ijph.in/text.asp?2022/66/3/331/356587



Substance use is associated with high-risk behaviors such as injecting drug use (IDU), sharing of injecting equipment, and high-risk sexual behaviors (HRSB). India has about 4.8 lakh people who inject drugs (PWID).[1] The PWID are at a high risk of health problems including HIV and HBV. While at the national level about 6.3% of PWID are HIV positive,[2] the prevalence varies widely at the subnational levels. The various risk factors associated with increased likelihood of HIV infection includes age of first use, IDU, duration, HRSB, and needle sharing.[3],[4],[5] In an earlier report, around 8% of PWID seeking drug treatment at a tertiary care hospital were found to be HIV positive.[6] Understanding the factors associated with HIV infection in addiction treatment settings may help in the early diagnosis of HIV and subsequent impact on intervention and health. We aimed to examine clinical characteristics of HIV-positive patients.

The study was conducted at a national level tertiary care drug treatment center located in North India. All patients seek treatment voluntarily and are offered various diagnostic and therapeutic services. HIV screening is advised by clinicians for patients who are deemed to be at risk for HIV infection based on the perceived need (as indicated by the history of high-risk behaviors).

A retrospective study was carried out among records of patients who were screened for HIV and found positive during a decade from 2008 to 2018. Patients for whom complete clinical records were retrieved are included in the study. Detailed information on sociodemographics, drug use, and clinical profile was extracted using a semistructured pro forma. The pro forma included data on patients profile (age, gender, education, marital status, and occupation), drug use profile (onset of use, type of substance, duration, and primary drug of use), and clinical profile (diagnosis, treatment history, and reason for HIV screening, and presence or absence of any health-related complications). Drug use was ascertained either by self-report or by urine screening at the center's laboratory. History of past treatment seeking was operationally defined as “visiting (even a single visit) any treatment facility for drug-related problems in the past.” Data on health-related condition were retrieved as per the clinical record and included general health conditions such as weakness, weight loss, loss of appetite and sleep, varicose vein, frequent fever, or any other medical condition. Ethical approval was obtained from the Institute Ethical Committee and complete confidentiality was ensured during the conduct of the study.

The data retrieved from files were entered into MS Excel sheets as per the study pro forma. The association between treatment seeking and medical condition was calculated with Chi-square test. All the analysis was done using the SPSS version 20.0 (IBM Corp, Armonk, NY, USA).

The study is based on records of 138 patients who were found HIV positive (all males). The clinical and drug use profile of the patients are presented in [Table 1]. The primary diagnosis was found to be ODS/IDU among 98% of patients. The common referral reasons for HIV screening were IDU (92.8%), followed by needle sharing (66.7%). The median age of the onset of IDU was 24.5 years. One-fourth of the patients started their first IDU use by 20 years of age. First IDU was observed as early as 10 years of age, whereas the maximum age was till 44 years.
Table 1: Clinical characteristics of the patients diagnosed with HIV (n=138)

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The reason for first IDU use was to get a high (62%) and peers (32.5%). It was seen that among opioids (IDU), buprenorphine injection was the most common, followed by heroin and then pentazocine [Table 1]. Duration of IDU varied from 0 to 25 years. More than half (60%) of the patients were found to be unaware about HIV at the time of IDU use. The use of gateway drug before/up to the age of 20 was prevalent (80%) through oral route (94%). The gateway drug (%) as per the prevalence was nicotine (45), opioids (22.5), cannabis alone or with nicotine (20), and combination including all the three (8). Interestingly, in this population, a very small number of patients n (%), 6 (4.5) were consuming alcohol along with nicotine as their gateway drug [Table 1].

Forty percent of patients were seeking treatment for the first time regarding their drug use problems (i.e. the index treatment contact when HIV screening was conducted). Among those who reported seeking treatment in the past, the median duration of treatment in any treatment setting was reported to be 1 month with variations from 0 to 288 months (median 1 month, interquartile range 1–5.3 months). The presence of any general medical condition was reported by more than half of the patients. An association between past treatment seeking and medical problem clearly indicated an inverse relation between the two [Table 2] (χ2 = 57.681, df = 1, P < 0.001).
Table 2: Correlation between treatment seeking before HIV screening and presence or absence of any general medical condition (n=138)

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The present study attempts to present the clinical characteristics associated with HIV-positive status among patients seeking treatment for drug use disorders. The profile of the patients revealed majority of the subjects with low education (up to primary). A nationwide study reported men with no education or with primary education have higher odds ratio (1.94) of being HIV positive.[7] Other factors such as being single or separated and unemployed were present in small group while majority were married and employed in this sample.

A majority of patients had a history of IDU. The association of IDU and transmission of HIV have been well studied.[5] The median age of the initiation of IDU was 25 years, with recorded age of initiation being as low as 10 years for some participants. The median age of initiation was similar to the studies reporting such figures from Delhi and Central India[8],[9] and was higher than age of initiation in North Eastern parts of India. Buprenorphine was the most common opioid drug of IDU in this population. This finding is similar to by Ganapathi et al., (2019)[3] and Lucas et al.[5] Alcohol and tobacco use were also common in this population, similar to what has been reported previously.[6]

High rates of the occurrence of general medical conditions were also reported in injecting drug users from our center.[6] Interestingly, patients who received treatment for SUD previously were less likely to have any general medical conditions. This suggests that possibly several of general medical conditions such as weakness and reduced appetite were tended to with the treatment. Effective treatment for SUDs may result in good medical outcomes in individuals who have HIV infection as well. Another finding was that HRSB was noted in one out of five individuals who were seropositive for HIV. This means that not only the spouses of IDU with HIV are vulnerable to transmission of the infection[10] but also their other sexual contacts may also be vulnerable. This calls for condom promotion to protect noninjecting contacts of PWID.

One of the main findings of the study was the median age of initiation of IDU being 25 years suggest that IDU use largely occurs after the adolescence is over (although there were some who started injection drug use early). Thus, preventive efforts in the context of injection drug use may be continued to be addressed in adults rather than focusing only in adolescents. In addition, those who received treatment have lower rates of general medical condition suggests that provision of adequate treatment facilities primarily to IDU may improve their overall health. Furthermore, considering that buprenorphine is a commonly injected drug by the PWID. Efforts are required to prevent the diversion of this medication from licit to illicit channels.

Some limitations of the study merit attention as well. This was a retrospective study, so issues such as limitation of information and nonstandardized data capture may be applicable. In addition, follow-up assessments of linkage to antiretroviral treatment (ART) and information of other viral markers are not the focus of this article. The study was limited to a single, public-funded center, and the results may not be generalizable to other centers or to the community.

To conclude, the present study suggests that a history of seeking treatment for SUD before HIV screening is associated with better general medical condition. In addition, there is a variability in the age of initiation of IDU, indicating a need for broad-based approach to prevent injection drug use. Future studies should look at the processes of linkage with and outcome of ART in PWID living with HIV, the specific facilitators and difficulties of treatment faced by them, and the impact of varied interventions on the improvement in physical health of the individuals with SUDs with HIV who are treated.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Ambekar A, Agrawal A, Rao R, Mishra A, Khandelwal S, Chadda R. on behalf of the group of investigators for the National Survey on Extent and Pattern of Substance Use in India, 2019. Magnitude of Substance Use in India. Ministry of Social Justice and Empowerment, Government of India, New Delhi.  Back to cited text no. 1
    
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India | UNAIDS [WWW Document]; 2020. Available from: https://www.unaids.org/en/regionscountries/countries/india. [Last accessed on 2020 Jun 06].  Back to cited text no. 2
    
3.
Ganapathi L, McFall AM, Srikrishnan AK, Kumar MS, Anand S, Lucas GM, et al. Young people who inject drugs in India have high HIV incidence and behavioural risk: A cross-sectional study. J Int AIDS Soc 2019;22:e25287.  Back to cited text no. 3
    
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Kumar P, Sangal B, Ramanathan S, Ammassari S, Venkatesh SR. Unsafe injecting practices, sexual risk behaviours and determinants of HIV among men who inject drugs: Results from Integrated Biological and Behavioural Surveillance in India. Int J STD AIDS 2018;29:1066-75.  Back to cited text no. 4
    
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Lucas GM, Solomon SS, Srikrishnan AK, Agrawal A, Iqbal S, Laeyendecker O, et al. 2015. High HIV burden among people who inject drugs in 15 Indian cities. AIDS Lond Engl 2015;29:619-28.  Back to cited text no. 5
    
6.
Quraishi R, Jain R, Pattanayak RD. Laboratory profile of current injecting drug users seeking treatment at a tertiary care center in India: What do the regular blood tests and HIV screening say? Addict Disord Their Treat 2012;11:206-11.  Back to cited text no. 6
    
7.
Perkins JM, Khan KT, Subramanian SV. Patterns and distribution of HIV among adult men and women in India. PLoS One 2009;4:e5648.  Back to cited text no. 7
    
8.
Strathdee SA, Stockman JK. Epidemiology of HIV among injecting and non-injecting drug users: Current trends and implications for interventions. Curr HIV/AIDS Rep 2010;7:99-106.  Back to cited text no. 8
    
9.
Saini R, Rao R, Parmar A, Mishra AK, Ambekar A, Agrawal A, et al. Rates, knowledge and risk factors of non-fatal opioid overdose among people who inject drugs in India: A community-based study. Drug Alcohol Rev 2020;39:93-7.  Back to cited text no. 9
    
10.
Ambekar A, Rao R, Mishra AK, Agrawal A. Type of opioids injected: Does it matter? A multicentric cross-sectional study of people who inject drugs. Drug Alcohol Rev 2015;34:97-104.  Back to cited text no. 10
    



 
 
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