A US survey of 1686 women with HIV on antiretroviral treatment found that 29% who used crack regularly or intermittently were almost 60% more likely to develop an AIDS-defining disease (opportunistic diseases as many say), and the 3,2% they were persistently three times more likely to die.
Women With HIV Who Use Crack Are Devastated
Persistent users were also found to have baseline HIV viral loads that were, on average, three times higher than intermittent or nonuser users. And that this persisted throughout the study despite antiretroviral treatment, also known as Antiretroviral Therapy or HAART. This High Viral Load actually complicated the CD4 count by creating "immunological gaps"Which increased the risk of opportunistic diseases
This was partly due to the lower levels of HAART (acronym in English for Highly Effective Antiretroviral Therapy, free translation). But progression of HIV disease in crack users and mortality in persistent users remained greater even when numbers were adjusted for reported compliance and baseline viral load and counting of CD4.
This was the first longitudinal study of a large group of women to confirm what most, but not all cross-sectional studies have found - that the use of crack and cocaine appears to exacerbate the effects of HIV regardless of treatment status and adherence.
Women With HIV Who Use Crack Is Three Times Greater
The Women's Interagency HIV Study (WIHS) is a prospective cohort study on the progression of HIV disease among 2058 women with HIV at six HIV centers in Chicago, Los Angeles, the San Francisco Bay Area, Washington DC and Brooklyn and Bronx in New York. The present study examined 1686 women who did at least two study visits between April of 1996 and September of 2004. The study visits were every six months, but the women did not have to have two consecutive ones to be included in the study. Women did an average of 12 study visits, with an average follow-up time of 18 to 20 months. Persistent crack users made only an average of six study visits but had a longer follow-up time of 33 months.
My life story, though extremely painful to me, has given me a lot of knowledge about what is misery and what is "just poverty." Scholars say they live below the poverty line and therefore, in the condition of miserable, all those who live on less than $ 1,00 per day.
I've seen something worse than that, projected in my own life, when, in a sad episode, I expected a "Fast Food" company to throw it away, which for them was no longer edible, and from this garbage I I tried, often having to solve this on the basis of the punch and the "kick", to get hold of a sandwich "I know what is misery and when, today, people with evident less than 28 years of age tell me they are" extreme right "I ask:
- "Forgive me, sir, they do not know what they say" ...
And they do not know it, because, among other things, they will never stay in the street for more than two days simply because they have no one to return to or a place to go and, on the other hand, they "try to eat less" because, 170 of height and bearing 68KG, are too fat. It's okay to go and eat raw tomatoes!
I would still have a lot to say, but I would run away from the scope of the text and the message I wanted to give is given. But I leave this paragraph below in sestaque and a link to the original text when cleaving in the image above.
Misery potentiates misery. And not everyone is afraid or ashamed of committing a crime. And even worse, a lot, but many of them, in fact, are ashamed to even ask. To illustrate, once I asked for a person, in a point of the city of São Paulo, in the vicinity of that famous corner, and the person gave the snack.
I was FA-MIN-TO and I did not ....
I took a nice bite of the snack, and less than seconds later, my mouth began to burn, to burn and I gasped. Everyone laughed and, to "mitigate my suffering, they gave me water.
The water was hot and salty. So are the people.
I narrated these facts to a social worker on CRT-A, where I would have visited him on invitation.
He was perplexed, and nowadays, as far as I know, he is working, yes, as a social worker, attending to homeless people. IF you know how, you can and want to do like him, do it, because publishing this here also has this purpose
Complications With CD4 Count Are Inevitable In People Who Have HIV That Catch Crack
At the baseline of the study, 483 women (28,6%) admitted to using crack. These were divided into 429 intermittent users (25,4%), who reported only the use of crack in some study visits, and 54 persistent users (3,2%) who reported using crack at all visits. At each clinic visit, intermittent users were split into "intermittent abstinence" users who used crack in the past, but who were not currently "intermittent active" users who reported current use, but had not done so on all previous visits. Fifty-six percent of the women were African-American, 24% Latino and 20% white or other ethnicities. Crack users were more likely to be black (70% of crack users were African American), dropping out of high school (especially persistent users), and consuming problematic alcohol along with crack - 10% of non-crack users , 27% of intermittent users, and 32% of persistent users also had drinking problems.
Antiretroviral Therapy, It Really Works
At the start of the study, 73% of women were currently on HAART (ART) or had been in the past, but only 32% of persistent crack users had exposure to antiretroviral drugs. Adherence to ART in study participants was not high, although the definition of high adherence was the most accurate of more than 95% of the doses taken since the last visit, at all visits. Twenty-nine percent of non-crack users, 16% of intermittent users and only 7% of persistent users (four women) reported high adherence as defined.
Large and CD4 Lower Scores Were Omnipresent in Women with HIV Who Use Crack
Persistent crack users had higher viral loads and lower counts of CD4 at the beginning of the study. The average viral load at the beginning of the study was 11.000 copies / ml in non-users, 10.300 copies / ml in intermittent users and 34.000 copies / ml in persistent users, while the initial counts of CD4 were 364, 433 and 257 cells / mm3 respectively . Forty percent of persistent crack users had initial CD4 counts below 200 (Table of laboratory-determined AIDS), compared to 29% of non-users and 22% of intermittent users.
High Mortality Rate Among Persistent Crack Users
There was a high mortality rate among participants, with 25% of women who died from any cause during the study period - 419 deaths in total, of these, 47% were related to AIDS, 33% non-AIDS-related and the remainder, indeterminate.
The dramatically higher mortality among persistent crack users.
Thirty-seven of the persistent 54 users died during the study - 68%. This may be partly due to selection bias: women who died had less time to stop using crack and became classified as intermittent users.
The fee of Estimated survival in 3.000 days was only 65% for persistent crack users of 89% for non-users, 90% for intermittent users.
The highest mortality rate among persistent users remained (mean prognosis, 3,61) when values were adjusted for age, race, income, education, alcohol consumption, adherence to ART and CD4 count and viral load at baseline.
Just under a third of women (32,3% or 543 women) developed a new AIDS-defining disease during the study. The progression of HIV infection to AIDS was significantly higher among intermittent users of crack (42%) and persistent users (39%).
Persistent and intermittent use of crack remained associated with progression of HIV infection to AIDS after adjustment for adherence, consumption, socioeconomic status, baseline viral load, and baseline CD4 count.
Persistent Users of Crack Has HIV Infection Course Towards AIDS Faster
In the adjusted analysis, intermittent users were 57% more likely, and persistent users, 65% more likely, to develop AIDS than non-users.
The proportion of women with CD4 below 200 cells / mm3 remained at 25% at intermittent users, declined over the course of the 29% study at the beginning to 17% at the end of the study in non-users, and varied irregularly between 23% and 45% on persistent users. Likewise, the proportion of women with viral load above 100.000 copies / ml fell from 17% at the beginning to 2% at non-users at the end of the study and from 17% at intermittent users to 8%, but at persistent users after an initial decline of 47% to 3%, then ranged between 8% and 27% for the remainder of the study.
Use of Crack and Viral Load
The use of crack was the most important influence on viral load and CD4 count in the study. Women who have used crack in the past, but currently do not use it (so stated) have 67% more likely to have a CD4 count below 200 (at risk and 45% more likely to have a viral load than 100.000 xNUMX% and 98% more likely to have CD58s below 4 cells / mm200 and a viral load above 3 copies / ml, respectively, while users Persistent subjects had 100.000% more likely to have a CD82 cell count below 4 cells / mm200 and 3%, or more than three times, most likely with a viral load exceeding 224 copies / ml (all values adjusted for other variables) .
Alcoholism Is Another Problem
The only other significant influences in the CD4 and / or viral load were the persistent consumption of problems (alcohol users were almost twice as likely to have a viral load above 100.000 copies / ml, although there was no influence on CD4 counts). being Latin 69% more likely to have less than 200 CD4s, with the potential for risk of PCP, Pneumocystosis, a potentially fatal opportunistic disease! A friend of mine has lost her nephew in this profile, but no crack use - so the annual exam is highly recommended), low income (20% more likely to have a low CD4 count and 26% more likely to have a high viral load) , age (42% more likely to have a low CD4 count for each 10 years of age increase, no effect on viral load) and finally adherence: women with more than 95% of adherence were less than half the probability of having CD4 below 200 cells / mm3 and less than one third likely to have a viral load above 100.000 copies / ml.
However, persistent use of crack was even more likely to predict a high viral load than high adherence was predicting a low.
An interesting finding was that low levels of ART adherence and high rates of morbidity and mortality were not associated with low levels of health care. In their latest interview, 100% of participants reported having seen an infectious or general practitioner physician in the last six months and 93% said they viewed the same provider consistently, including 94% of persistent crack users.
Are the findings of the study due to the direct effects of crack on the immune status and replication of HIV in users?
Previous studies have shown that cocaine causes immune changes in T cells, inhibits the functions of other immune cells such as macrophages and neutrophils, suppresses cell signaling (cytokines), and increases HIV replication in the cells of the "in vitro. "
Recent studies have also found that cocaine increases the permeability of the blood-brain barrier, thereby increasing the vulnerability of the central nervous system to HIV infection, and that crack users develop chronic lung disease by inhaling crack contaminants. There was a predominance of respiratory diseases in women who developed AIDS defining conditions; 18% developed bacterial pneumonia, 10% PCP and 4% TB - My observation. Anyone must be, needlessly, tested for the presence of HIV - Tuberculosis, TB, is AIDS defining disease.
AIDS, or Crack, Can Reach Anyone or Family
On the other hand, this study can not rule out other explanations for greater morbidity and mortality among persistent users of crack, as an increased risk from sexually transmitted diseases. And, worse food, lack of housing and real adhesion in relation to that reported.
The biggest weakness is that researchers did not collect urine or blood samples to measure true exposure to crack and alcohol and also did not take direct measures of HIV drug levels or other direct ways of monitoring adherence and exposure to HAART.
The speech is always the same:
- Ah! I always use a condom!
- I'm clean - The subliminal message is: Claudio, You're filthy!
I do not blow bullet with paper- Defendant I confess, this was MY SPEECH
Research in prevention studies has shown that adherence self referral is not always reliable.
And I insist: There is life with HIV
Although the results are highly suggestive that crack and cocaine directly worsen HIV infection, it is still an open question whether drugs or the lifestyle of drug users causes more harm.
More about AIDS in association with drugs
Read me! I lived a life without guilt
Immunologic window. I have a text about immunological window whose technical part has been drafted and is constantly revised.
Translated by Cláudio Souza do Original Women with HIV who use crack are three times more likely to die
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