Clinical and biological characteristics of human immunodeficiency virus-infected and uninfected intravascular drug users in Ho Chi Minh City, Vietnam.

Abstract

To define the medical characteristics of intravascular drug users in Ho Chi Minh City, Vietnam, we examined 280 men, of whom 235 were infected with human immunodeficiency virus (HIV), being treated in a rehabilitation center. The patients used mainly opium, often in shooting galleries (50%). The prevalence of oral candidiasis (58%) and zoster infection (20%) was high in HIV-seropositive patients, whereas oral hairy leukoplasia and Kaposi's sarcoma were absent. The prevalence of acquired immunodeficiency syndrome was 24%. More than 80% of the patients had infections with hepatitis C virus, hepatitis B virus, cytomegalovirus, or human T cell lymphotropic virus type-1. The CD4ϩ cell counts correlated well with viral load. Only HIV-1 subtype E was detected in the 30 patients tested. A cohort study of HIV-infected subjects in this population seems feasible, and would permit introduction of anti-retroviral therapy The large number of HIV-seronegative subjects sharing the same at-risk practices as the HIV-infected subjects raises the possibility of natural protection in this population.

Cutting Edge: Increased NK Cell Activity in HIV-1-Exposed but Uninfected Vietnamese Intravascular Drug Users

“…Thirty-seven individuals who had been in high risk of exposure to HIV-1 were recruited from a population of seronegative subjects identified between 1996 and 1998 among IDUs treated in the Binh Trieu Detoxification Centre in Ho Chi Minh City (12). The prevalence of risk factors and of other infections was similar in these seronegative IDUs and in the HIV-infected IDUs attending this center (12).…”

“…The contribution of NK cells to anti-HIV defenses can be inferred from studies showing alterations of NK cell function and number during HIV infection and progression to AIDS (7-9) Moreover, in vitro-activated NK cells secrete ␤ chemokines and other cytokines that inhibit HIV infection (10) and this activity is affected by the level of viremia in HIV-infected patients (11). To evaluate the role of NK cells in the resistance against HIV-1, we studied NK cell function in a group of highly exposed seronegative intravascular drug users (IDUs) in Ho Chi Minh City, Vietnam (12). We chose this study group since factors, such as shared needle injections and multiple viral infections, found in Vietnamese IDUs (12) favor immune activation which may result in enhanced innate defenses, including NK cell responses, which in turn may interfere with the transmission of HIV.…”

Evidence for the innate immune response as a correlate of protection in human immunodeficiency virus (HIV)-1 highly exposed seronegative subjects (HESN)

“…Mucosal exposure to HIV-1 in Resistance to infection despite direct blood-borne exposures to HIV-1 were also seen among HIV-seronegative occupationally exposed health workers [14], haemophiliacs receiving tainted blood products [15,16] and i.v. drug users sharing needles [17][18][19][20]. The potential diversity of the exposure routes and varied epidemiological background of HIV-1 exposed, uninfected subjects initially complicated the creation of a unifying definition for these seemingly resistant individuals [21].…”

“…Nevertheless, studies of commercial sex workers and i.v. drug users have inferred exposure to HIV-1 based upon mathematical models of the frequency of high-risk activity and the prevalence of HIV-1 in the community being studied [1,18,22].…”

Genetic Association of the Antiviral Restriction Factor TRIM5α with Human Immunodeficiency Virus Type 1 Infection

“…Humans demonstrate significant variability in their susceptibility to human immunodeficiency virus type 1 (HIV-1) infection (5,11,12,14,37) and to disease progression after seroconversion (7,19,24,27,28). Variation in human genes having innate antiviral function may contribute to these differences through subtle, but significant alterations in gene expression or protein function.…”