Jag H. Khalsa

Introduction: HIV/AIDS and Aging.

AIDS 2004, 18 (suppl 1):S1–S2This supplement to AIDS is dedicated to research onCNS-related comorbidities and complications in HIV-infected older adults as discussed at the NationalInstitute of Mental Health workshop (‘Mental HealthResearch Issues in HIV Infection and Aging’) held inWashington, D.C., in April, 2002

Clinical consequences of marijuana.

As documented in national surveys, for the past several years, marijuana has been the most commonly abused drug in the United States, with approximately 6% of the population 12 years and older having used the drug in the month prior to interview. The use of marijuana is not without significant health hazards. Marijuana is associated with effects on almost every organ system in the body, ranging from the central nervous system to the cardiovascular, endocrine, respiratory/pulmonary, and immune systems. Research presented in this special supplement will show that in addition to marijuana abuse/dependence, marijuana use is associated in some studies with impairment of cognitive function in the young and old, fetal and developmental consequences, cardiovascular effects (heart rate and blood pressure changes), respiratory/pulmonary complications such as chronic cough and emphysema, impaired immune function leading to vulnerability to and increased infections, and the risk of developing head, neck, and/or lung cancer. In general, acute effects are better studied than those of chronic use, and more studies are needed that focus on disentangling effects of marijuana from those of other drugs and adverse environmental conditions.

Medical Consequences of Drug Abuse and Co-Occurring Infections: Research at the National Institute on Drug Abuse

ABSTRACT Substance abuse still remains one of the major problems in the world today, with millions of people abusing legal and illegal drugs. In addition, a billion people may also be infected with one or more infections. Both drugs of abuse and infections are associated with enormous burden of social, economic, and health consequences. This article briefly discusses a few medical consequences of drugs of abuse and infections such as human immunodeficiency virus, hepatitis C virus, psychiatric complications in hepatitis C infection, pharmacokinetic drug–drug interactions among medications used in the treatment of addiction and infections, and new drugs in development for the treatment of infections. Research is encouraged to study interactions between infections, drugs of abuse, and underlying pathophysiologic and molecular/genetic mechanisms of these interactions.

Body Image Disorders and Abuse of Anabolic-Androgenic Steroids Among Men.

During the last several decades, the image of the idealized male body in many countries has shifted toward a substantially higher level of muscularity. Bodybuilding competitors, male models, and even children’s action toys (eg, “G.I. Joe”) have become significantly more muscular than their predecessors of the 1960s. Nowadays, young men are constantly exposed to muscular male images on magazine covers, in advertisements, on television, and in movies. Perhaps as a consequence of these trends, young men have become increasingly concerned with their muscularity, reflected by an increasing prevalence of “muscle dysmorphia,” a form of body image disorder characterized by an obsessive preoccupation with a muscular appearance.1,2 First described in the scientific literature less than 25 years ago, muscle dysmorphia has now become the subject of numerous reports and has been included as an official diagnosis in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).2 Approximately 2.2% of US men have been reported to have body dysmorphic disorder, and among these men with body dysmorphic disorder, 9% to 25% have muscle dysmorphia, which would suggest the

Addressing the Need for Treatment Paradigms for Drug-Abusing Patients with Multiple Morbidities

Persons who use and abuse drugs are at risk for multiple morbidities that involve addiction, bloodborne infectious diseases, and sexually transmitted diseases, in addition to psychiatric illness and social instability. Infectious diseases acquired as a result of drug use can diffuse into non-drug using populations through other high-risk behaviors. Drug users also have substantial comorbidities from noncommunicable diseases and complications that can affect virtually every organ system in the body. Diagnosis of comorbidities and complications associated with drug abuse usually occurs late in the disease course, particularly for persons who are disenfranchised and have limited or no access to medical care. Medical management of these comorbid conditions constitutes a significant challenge. Directly observed therapy (DOT) can be useful but needs to conform to the needs of the targeted treatment population for full efficacy. DOT may have its greatest impact with drug users destabilized by cocaine or methamphetamine use but has yet to be fully investigated in this patient population.

Hepatitis C Virus Infection and Substance Abuse: Medical Management and Developing Models of Integrated Care—An Introduction

Reprints or correspondence: Dr. Thomas F. Kresina, Div. of Pharmacotherapies and Medical Consequences of Drug Abuse, National Institute on Drug Abuse, National Institutes of Health, 6001 Executive Blvd., Bethesda, MD 20892 (tk13v@nih.gov). Clinical Infectious Diseases 2005; 40:S259–62 2005 by the Infectious Diseases Society of America. All rights reserved. 1058-4838/2005/4009S5-0001

Gender Differences in Early Life Risk Factors for Substance Use/Abuse: A Study of an African-American Sample

15.00 Persons who use illegal drugs, who have a history of illegal drug use, or who have become addicted to illegal drugs through injection drug use constitute a majority of the patients with incident hepatitis C virus (HCV) infection. These persons are at risk for other infectious diseases, such as HIV infection, and exhibit comorbidities associated with drug use, such as psychiatric illness. The medical management of HCV infection in these patients is complex and challenging. The 2002 National Institutes of Health (NIH) Hepatitis C Consensus Conference recommended treatment for HCV for injection drug users (IDUs), as determined on a case-by-case basis. This recommendation does not provide substantial guidance and support for healthcare providers dealing with the complex and challenging health-care issues associated with substance abuse and hepatitis C. To elucidate more fully the NIH Consensus Conference Statement on issues related to substance abuse, the National Institute on Drug Abuse of the NIH sponsored a conference to address the clinical issues associated with HCV infection, care, and treatment in the context of drug use to define research gaps for future research initiatives. The conference was held on 11– 13 November 2003 in Washington, DC. Cosponsors included the Office of AIDS Research, National Institute of Allergy and Infectious Diseases, and National Institute of Diabetes and Digestive and Kidney Diseases of the NIH, the Department of Veterans Affairs, and the Health Resources and Services Administration. The conference brought together infectious diseases specialists, hepatologists, and those who care for persons with substance abuse, to identify issues in the treatment of patients with HCV infection and coinfection with HIV and HCV, to discuss the development of models for integrated care and treatment of patients infected with HCV and coinfected with HIV and HCV, and to identify gaps in knowledge that can be addressed by a research agenda.

Drug Interactions between Antiretroviral Medications and Medications Used in the Treatment of Drug Addiction: Research Needs

Gender differences in risk and protective factors for substance use/abuse in early adulthood were studied. Comprehensive systematic data on African-American males (N = 318) and females (N = 322), from birth to 7 years of age, were available from the National Collaborative Perinatal Study. These subjects were retrieved for assessment at average age 24. There are more differences between males and females than there are similarities in regard to the early childhood variables that predict substance use in early adulthood. However, high activity and intensity of response during infancy (measured at 8 months of age) was found to predict later substance use for both males and females. This type of behavior is considered by use to be a trait of temperament and to suggest the possibility of a genetic predisposition. More risk factors were found for female than for males. The risk factors for females were primarily of two types: 1) Related to experiences with mother and with the family environment; and 2) Poor levels of intellectual functioning and academic performance, and abnormal mental status.

Medical Management of HIV—Hepatitis C Virus Coinfection in Injection Drug Users

Today substance dependence is one of the major public health problems in the world with millions of people abusing legal and illegal drugs. In addition, almost one-third of the worlds population suffers with one or more infections. Both drugs of abuse and infections are associated with serious medical and health consequences, some of which may be exacerbated by the occurrence of pharmacokinetic and/or pharmacodynamic interactions between medications used in the treatment of these conditions when they co-occur. This review briefly discusses issues surrounding clinical management related to drug interactions experienced by substance abusing patients. The emphasis of this paper is on the research needed to further study the extent, nature, and underlying molecular/genetic mechanism(s) of interactions between drugs of abuse, medications used in the treatment of drug addiction, and co-occurring infections.

Interventions for HIV and hepatitis C virus infections in recreational drug users.

Several million people inject drugs of abuse and, as a result, are coinfected with human immunodeficiency virus (HIV) and hepatitis C virus (HCV). The treatment of this coinfected drug-abusing population is fraught with many problems such that clinicians and other health care providers have to determine whether patients should be treated first for drug addiction, for HIV/AIDS, or for HCV infection or simultaneously treated. These proceedings present the incidence and prevalence of coinfections with HIV and HCV in high-risk populations and discuss the underlying pathophysiology of coinfections and the problems and strategies of managing the treatment of coinfections among people who also inject illicit drugs. In addition, the expert panel recommended further research to determine the best possible treatment regimens applicable to injection drug users coinfected with HIV and HCV.