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HIV AIDS and Substance Use Disorders PowerPoint Presentation

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Description : This medical presentation titled ""HIV/AIDS and Substance Use Disorders"" is about HIV/AIDS substance use disorders, explores the connection between HIV and substance use disorders, and lists of its implications for patient care.

Tags : substance, disorders, Human Immunodeficiency Virus, HIV, infection, cells, immune system, AIDS, Acquired Immune Deficiency Syndrome, HIV Positive, RNA virus

Published on : Apr 23, 2021 | Views : 1362 | Downloads : 2

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Slide 1-

HIV/AIDS and Substance Use Disorders Olivera J. Bogunovic, M.D. State University of New York at Buffalo Alcohol Medical Scholars Program
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Copyright Alcohol Medical Scholars Program 2 Lecture Overview HIV/AIDS Substance use disorders Connection between HIV and substance use disorders Implications for patient care
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Copyright Alcohol Medical Scholars Program 3 Patient: John 40-year old white male presents to ER with: Diarrhea >1 month, thrush, weight loss History: Intravenous heroin user Failed inpatient rehabilitation Labs: CD4 <400
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Copyright Alcohol Medical Scholars Program 4 HIV - Human Immunodeficiency Virus RNA virus Principally infected cell: CD4 T cell Progressive loss of cell
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Copyright Alcohol Medical Scholars Program 5 Epidemiology >39 million HIV+ ~40,000 persons infected/year (CDC) High-risk populations: Injection drug users: 26% of all infections Homosexual males: 60% of all infections
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Copyright Alcohol Medical Scholars Program 6 HIV Transmission Categories Centers for Disease Control, 2005
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Copyright Alcohol Medical Scholars Program 7 Other HIV Transmission Categories Maternal transmission during childbirth Health workers Blood transfusions Tattoos
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Copyright Alcohol Medical Scholars Program 8 Course of HIV Infection Six stages of infection: Initial Latency Lymphadenopathy Early symptomatic infection AIDS End stage
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Copyright Alcohol Medical Scholars Program 9 Treatment of HIV/AIDS Prevention of HIV transmission Antiretroviral treatment:  immune function  viral replication Treatment of opportunistic infections
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Copyright Alcohol Medical Scholars Program 10 Antiretroviral Medications Nucleoside and nucleotide analogs (zidovudine) Protease inhibitors (saquinavir) Non-nucleoside transcriptase (nevirapine)
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Copyright Alcohol Medical Scholars Program 11 Lecture Overview HIV/AIDS Substance use disorders (SUD) Connection between HIV and substance use disorders Implications for patient care
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Copyright Alcohol Medical Scholars Program 12 Relevant Drugs to HIV/AIDS Opioids Stimulants Amphetamine Cocaine Alcohol
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Copyright Alcohol Medical Scholars Program 13 Substance Use Disorders Misuse = use to get high Abuse = dysfunction in 1+ life areas Dependence = 3+ of 7 criteria Physical dependence Compulsive use/loss of control
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Copyright Alcohol Medical Scholars Program 14 Lifetime Prevalence Opioids Abuse/dependence of heroin <1% Stimulants Amphetamine Abuse/dependence < 2% Cocaine Abuse/dependence 2% Alcohol Abuse or dependence 10-15% men, 8-10% women
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Copyright Alcohol Medical Scholars Program 15 Routes of Administration Injection: highest risk of infection Intranasal Smoking Oral
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Copyright Alcohol Medical Scholars Program 16 Treatment Individual and group psychotherapy Pharmacotherapy Self help groups
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Copyright Alcohol Medical Scholars Program 17 Lecture Overview HIV/AIDS Substance use disorders Connection between HIV and substance use disorders Implications for patient care
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Copyright Alcohol Medical Scholars Program 18 Prevalence High prevalence of HIV in patients with SUD 35% of cocaine users 22% of opioid users High prevalence of SUD in HIV+ patients 25% alcohol dependent 25% use illicit opioids 33% use cocaine
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Copyright Alcohol Medical Scholars Program 19 Drug Use and HIV Transmission Highest risk with intravenous use Increased risk with intranasal use More sexual partners, unsafe sex Associated with alcohol use
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Copyright Alcohol Medical Scholars Program 20 Opioids Affect HIV Course Cause immunosuppression Induce apoptosis  viral replication Co-infection of HIV and other pathogens
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Copyright Alcohol Medical Scholars Program 21 Stimulants Affect HIV Course Cocaine Causes immunosuppression of T-cells  viral replication  brain cells infected  neurotoxicity Amphetamine Similar effect to cocaine Research beginning to accumulate
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Copyright Alcohol Medical Scholars Program 22 Alcohol Affects HIV Course  immune response to HIV infection  viral replication Promotes progression of illness  permeability of blood brain barrier to infectious agents
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Copyright Alcohol Medical Scholars Program 23 Drugs/Alcohol Affect HIV
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Copyright Alcohol Medical Scholars Program 24 Opioids Affect Antiretrovirals Opioids  high risk behavior / noncompliance Drug-drug interactions Methadone levels  with meds Methadone dose adjustment needed  blood levels of meds
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Copyright Alcohol Medical Scholars Program 25 Stimulants Affect Antiretrovirals Cocaine  risk behaviors Resistance to antiretrovirals in 30% due to noncompliance Amphetamine ↑ risk behavior
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Copyright Alcohol Medical Scholars Program 26 Alcohol Affects Antiretrovirals  risk behavior and noncompliance  viral replication  response to antiretroviral medications Impairs pharmacokinetics and pharmacodynamics of antiretrovirals
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Copyright Alcohol Medical Scholars Program 27 Drugs/Alcohol Affect Meds
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Copyright Alcohol Medical Scholars Program 28 Substance Use and Compliance with Medications Inconsistent outpatient care Noncompliance with medication regimen 44% users vs. 22% non-users Poor social support Methadone maintenance programs better adherence to treatment
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Copyright Alcohol Medical Scholars Program 29 Psychiatric Disorders, HIV & SUD Drugs/alcohol cause & exacerbate psychiatric symptoms Psychiatric symptoms more common HIV+ more sensitive to illicit drugs
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Copyright Alcohol Medical Scholars Program 30 Lecture Overview HIV/AIDS Substance use disorders Connection between HIV and substance use disorders Implications for patient care
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Copyright Alcohol Medical Scholars Program 31 Treatment Guidelines Maximizing care for HIV and SUD Medical treatment Asymptomatic infection: antiretroviral meds Symptomatic infection: treat opportunistic infection
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Copyright Alcohol Medical Scholars Program 32 Treatment Guidelines SUD treatment Reduce HIV risk behavior Harm reduction model Methadone maintenance Syringe exchange programs Mental health treatment
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Copyright Alcohol Medical Scholars Program 33 What About John HIV: treat with antiretrovirals SUD treatment: Consider methadone maintenance Cognitive-behavioral therapy Self-help groups Mental health treatment if indicated
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Copyright Alcohol Medical Scholars Program 34 Summary HIV/AIDS Substance use disorders Connection between HIV and substance use disorders Implications for patient care