Dennis G. Fisher

Hepatitis C virus and depression in drug users

Objective:Clinical case studies have implicated depression as a possible side-effect of interferon treatment for the Hepatitis C virus (HCV). However, because these studies generally did not include a pretreatment assessment of depression, it cannot be definitively stated whether depression is a side-effect of interferon treatment, a syndrome coexisting with HCV, or a common characteristic of individuals who are vulnerable to HCV infection. To gather more information about this issue, self-reported depressive symptomatology of drug users with HCV who have not received interferon treatment was compared to that of uninfected drug users.Methods:Subjects were 309 drug users not currently in substance abuse treatment who were participating in a National Institute on Drug Abuse project. Subjects completed the Center for Epidemiological Studies-Depression (CES-D) instrument and provided a blood sample for HCV testing.Results:Serological findings revealed that 52.4% of the subjects tested positive for HCV antibodies. Of the HCV-positive subjects, 57.2% had significant depressive symptomatology, whereas only 48.2% of the HCV-negative subjects did, for an overall rate of 52.6%. The two groups also differed on two specific dimensions of depression, with the HCV-positive group scoring lower on the Positive Affect scale and higher on the Somatic/Retarded Activity scale.Conclusions:These findings reveal high levels of depressive symptomatology among drug users, as well as the possibility of a coexisting depressive syndrome with HCV infection. These findings raise the possibility that depression associated with interferon treatment may, at least partially, be accounted for by preexisting depression. Further research is needed to determine the nature and origins of depression in individuals in treatment with interferon for HCV with specific focus placed on determining the dimensions of depression associated with HCV infection and interferon treatment.

Hepatitis A vaccine administration: comparison between jet-injector and needle injection

INTRODUCTION Type A hepatitis virus (HAV) is a serious health problem throughout the world and can be spread via fecal-oral contact. Both immune globulin and an HAV vaccine provide protection, but the vaccine gives complete protection. Efficacy of methods of vaccination in relation to the formation of anti-HAV antibodies is unclear; thus, this study seeks to determine if significant differences exist between the syringe as compared to the jet injection technique. The purpose of this study was to compare in a randomized trial Biojet jet-injection system to a needle-syringe method. To determine if a significant difference between these two methods in seroconversion rates or geometric mean titers of anti HAV antibody occurs at day 15, 30, and 210 days after vaccination. METHOD Anti-HAV IgG(-) adult hospital employees were randomized to receive 1440 EL.U of hepatitis a vaccine (HAVRIX(R)) in 2 doses by either needle or jet-injector (Biojector(R)) system at month 0 and 6. HAV seroconversion titer results were measured by the Boehringer-Mannheim method. RESULTS/DISCUSSION A higher proportion of persons who received HAV vaccine via the Biojector(R) seroconverted with anti-HAV level >/=20 mIU at day 15, 30, and month 7 when compared with a needle injection.Side-effect profiles reported by participants in both methods were below those identified in current published and insert information, but the Biojector(R) had greater local reactivity in all categories when compared to the needle method.

Providing hepatitis B vaccination to injection drug users: referral to health clinics vs on-site vaccination at a syringe exchange program.

Injection drug users (IDUs) are at very high risk for infection with hepatitis B virus (HBV) through multiperson use of injection equipment and through unprotected sexual contact. Although a safe and efficacious vaccine exists for hepatitis B, there are multiple problems in vaccinating IDUs in the United States, including (1) discrimination against drug users by health care providers, (2) the need to reach IDUs before they are exposed to HBV, (3) paying for the vaccinations, and (4) difficulties in completing the 3-injection vaccination series. We compared 2 methods for delivering free hepatitis B vaccination to IDUs: (1) referral by research staff to local health care providers and (2) on-site vaccination at a syringe exchange program.

The Reliability and Validity of Drug Users' Self Reports of Amphetamine Use Among Primarily Heroin and Cocaine Users

Relatively few studies have addressed the psychometric properties of self-report measures of amphetamine use. This study examines the reliability and validity of the Risk Behavior Assessments (RBA) lifetime and recent amphetamine-use questions. To evaluate validity, 4027 out-of-treatment primarily cocaine and heroin users provided urine samples that were compared to self-report data; to evaluate reliability, 218 completed the RBA at two time points, 48h apart. In the overall sample, self-reports demonstrated moderately high validity, with a 95% accuracy rate (kappa=.54). When analysis was restricted to recent amphetamine users validity was slightly lower (71.5% accuracy; kappa=.41). Test-retest data indicated good reliability for self-reports of ever having used amphetamine (kappa=.79), and amphetamine use in the past 30 days (.75<r<.91). Out-of-treatment drug users provided accurate self-reports of amphetamine use. Reliable and valid measures are essential for describing and predicting trends in amphetamine use, evaluating the effectiveness of interventions, and developing policies and programs.

Male-to-female transgender and transsexual clients of HIV service programs in Los Angeles County, California

Data on HIV risk were collected with the Countywide Risk Assessment Survey from 2126 participants; 92 were male-to-female transgender persons (i.e., cross-dressers, and those who identify with the opposite sex), and 9 were male-to-female transsexual individuals (i.e., those who have undergone gender-reassignment surgery or other procedures). Transgender-identified individuals were more likely than the rest of the sample to have received hormone injections, offensive comments, and HIV testing; injected hormones with a used needle; been Asian or American Indian; been paid for sexual intercourse; and lived in unstable housing but less likely to have used heroin. Transgender-identified individuals are at high risk for HIV infection because of reuse of needles and being paid for sexual intercourse.

Reliability and Validity of Not-in-Treatment Drug Users' Follow-Up Self-Reports

Based on a sample of 259 drug users not in treatment from five different sites, we examined the reliability of self-reported demographic and behavioral information and the validity of self-reported drug use. Data were collected twice with a 48-hr interval, using the Risk Behavior Follow-Up Assessment (RBFA; National Institute for Drug Abuse, 1992), a structured interview. We examined internal consistency and test–retest reliability and found that, overall, drug users were generally reliable reporters of information regarding their demographics, drug use, sexual behavior, work and income, and criminal behavior. Exceptions to these findings of reliability were noted for items that were phrased too broadly. Comparison of self-report data and urinalysis results indicates that drug users accurately report cocaine and opiate use, although reports of cocaine use were somewhat more valid. These findings indicate that self-report data from drug users, when collected by trained interviewers, can be considered reliable and valid.

Development of the Perceived Risk of HIV Scale

Past studies have used various methods to assess perceived risk of HIV infection; however, few have included multiple items covering different dimensions of risk perception or have examined the characteristics of individual items. This study describes the use of Item Response Theory (IRT) to develop a short measure of perceived risk of HIV infection scale (PRHS). An item pool was administered by trained interviewers to 771 participants. Participants also completed the risk behavior assessment (RBA) which includes items measuring risky sexual behaviors, and 652 participants completed HIV testing. The final measure consisted of 8 items, including items assessing likelihood estimates, intuitive judgments and salience of risk. Higher scores on the PRHS were positively associated with a greater number of sex partners, episodes of unprotected sex and having sex while high. Participants who tested positive for HIV reported higher perceived risk. The PRHS demonstrated good reliability and concurrent criterion-related validity. Compared to single item measures of risk perception, the PRHS is more robust by examining multiple dimensions of perceived risk. Possible uses of the measure and directions for future research are discussed.ResumenEstudios previos han utilizado varios métodos para evaluar los riesgos percibidos de la infección del VIH; sin embargo, pocos han incluido los varios elementos que cubren las diferentes dimensiones de la percepción del riesgo o han examinado las características de los elementos individuales. Este estudio describe el uso del “Item Response Theory” (IRT) para desarrollar una medida básica del riesgo percibido de la infección del VIH (PRHS). A 771 participantes se les administro un sorteo de elementos a mano de entrevistadores calificados. Los participantes también rellenaron evaluaciones de riesgo que incluyen elementos para evaluar comportamiento de riesgo sexual, y 652 de los participantes tomaron pruebas para el VIH. La medida definitiva constaba de 8 elementos, elementos que incluyeron la evaluación de la estimación de probabilidad, juicios intuitivos, prominencia de riesgo. Las puntaciones más altas fueron asociadas con un número más elevado de parejas sexuales, relaciones sexuales sin protección, y relaciones sexuales bajo el influjo. Los participantes que resultaron seropositivos para el VIH reportaron niveles altos de riesgo percibido. El PRHS demostró buena fiabilidad y validez de criterio relacionado concurrente. En comparación con los métodos de evaluación del riesgo percibido de un solo elemento, el PRHS es más robusto en examinar dimensiones múltiples de riesgo percibido. Usos posibles de la evaluación y direcciones para investigaciones en el futuro son discutidos.

Depression as Measured by the Beck Depression Inventory-II among Injecting Drug Users.

This study conducts a confirmatory factor analysis of the Beck Depression Inventory-II (BDI-II) with a sample of 598 individuals who reported recent injecting drug use. Findings indicate that out of four models tested, the best model for this sample is a three-factor solution (somatic, affective, and cognitive) previously reported by Buckley, Parker, and Heggie. The findings that nearly 50% of participants provided BDI-II scores indicating significant depressive symptomatology reveals that these individuals are in need of treatment for their psychiatric symptoms as well as substance use. Somatic symptoms are endorsed more strongly than affective or cognitive symptoms of depression, suggesting a possible, but yet poorly defined, relationship between depressive symptomatology and drug use that centers on shared somatic symptomatology.

Needle exchange and injection drug use frequency: A randomized clinical trial

Despite a lack of evidence that needle exchange programs (NEPs) cause an increase in injection drug use, there are still concerns over fostering increased injection behavior with NEPs. The design was a randomized controlled trial conducted from May 1997 to June 2000 comparing injection drug users (IDUs) who are randomly assigned to have access to an NEP versus training in how to purchase needles and syringes (NS) at pharmacies. Of 653 IDUs recruited into the study, 600 were randomized: 426 were followed-up at 6 months, and 369 were followed-up at 12 months. Four hundred ninety were followed up at least once. There was no difference in the number of injections over time between the NEP and the Pharmacy Sales arms of the study or in the percentage of positive urine test results over time between the NEP and the Pharmacy Sales arms of the study for morphine and amphetamine. The decrease in the presence of cocaine was marginally greater between the arms of the study. The results do not support the hypothesis of NEPs causing an increase in injection drug use. This clinical trial provides the strongest evidence to date that needle exchanges do not produce this negative effect.

Use of crystal methamphetamine, Viagra, and sexual behavior.

Purpose of review Methamphetamine (meth) use has been shown in the literature to be associated with high-risk sexual behavior for both homosexual (MSM) and heterosexual samples for over a decade. The use of Viagra has also been shown to be associated with high-risk sexual behavior. The purpose of this review is to update the record on Viagra and on the combination of Viagra and meth use. Recent findings There is now strong evidence that the use of Viagra is associated with HIV seroconversion in MSM. The combination of taking both meth and Viagra is strongly associated with much higher sexually transmitted disease and HIV rates. There is some evidence that Viagra is associated with insertive and meth is associated with receptive anal intercourse by men. Summary The evidence is strong to support the relationship between Viagra use and HIV seroconversion now that more sophisticated analyses have been done. The meth–Viagra recreational drug combination is of very high risk. More research is needed to generate longitudinal and event-level data that are necessary to answer fine-grained questions about drug combinations and the relationship with sexual behavior.