[sci.med] AIDS and Drug Usage

beth@sphinx.UChicago.UUCP (JB) (10/17/86)

[Defeat is worse than death because you have to live with defeat.]

In the November, 1986 issue of _American_Health_ magazine, there's an
article entitled "Drugs that Suppress Immunity".  The last part of the
article discusses AIDS, and I thought it might be of interest:

    AIDS is caused by a virus called human T-cell lymphotropic virus type
    III (HTLV-III), which attacks a specific kind of T-lymphocyte,
    virtually wiping out the body's infection-fighting T4 helper cells.
    When the virus gains a foothold, interferon production slows down, the
    B-lymphocytes and macrophages stop attacking invaders, and the NK
    [natural killer] cells quit mopping up tumor cells and virus-infected
    cells.  AIDS victims don't die from AIDS, they die from the illnesses
    that result from it -- the opportunistic infections and rare cancers
    ordinarily seen only in transplant patients whose immune systems have
    been suppressed by powerful drugs.

    "HTLV-III won't produce AIDS in a healthy person," asserts Washington,
    DC, internist Cesar A. Caceres.  "HTLV-III produces AIDS only if the
    immune system is already damaged."  Dr. Caceres and co-author Terry
    Krieger, in a controversial article published by _The_Wall_Street_
    _Journal_, state, "It appears that most AIDS patients are not healthy
    people who got AIDS simply because they had sex with the wrong person.
    Rather, they seem to be people who were already sick in the sense of
    having a damaged immune system [from drugs]."

    Caceres treats a number of AIDS patients in his Washington practice.
    Among these patients he noticed "an astonishing record of recreational
    drug use."  And, significantly, the drug use was not primarily intra-
    venous, but oral, and included marijuana, amphetamines, barbiturates,
    Quaaludes, LSD, PCP, cocaine, and amyl and butyl nitrites.  In going
    over the CDC data on risk categories of AIDS victims, Caceres and
    Krieger found that drug abuse, not homosexuality, was the most common
    risk factor.  The authors define drug abuse as using a recreational
    drug at least once a week.  "We find that at least 79% of AIDS patients
    have been drug abusers," Caceres says.

    One recreational drug has already been specifically tied to AIDS.  In a
    1981-82 study of AIDS patients with Kaposi's sarcoma (KS), a cancer of
    the blood vessels that is the one most often found among AIDS patients,
    Dr. Harry Haverkos of the National Institute of Allergy and Infectious
    Diseases found that the most distinguishing factor among the KS sufferers
    was their use of large quantities of nitrite inhalants.  "Nitrites affect
    the blood vessels," he says.  "The drug causes vasodilation, which many
    homosexuals believe enhances and prolongs sexual stimulation."  In his
    study, pulished recently in _Sexually_Transmitted_Diseases_, Haverkos
    found that nitrites were used by "nearly all" homosexual men with
    Kaposi's sarcoma.

    "We have enough evidence to warn people not to use drugs," says Nahas
    of Columbia.  Another researcher likens taking drugs to speeding on the
    highway:  "Most of the time you can probably get away with it.  But if
    you do it often enough, eventually there's going to be a cop around."

Note that the key word "controversial" is used to describe Caceres/Krieger's
theory that the immune system must already be damaged for HTLV-III to induce
AIDS.  Note also that, at least on the surface, their weighting of drug
abuse as a larger risk factor than homosexuality seems to contradict the
data that Craig Werner supplies us from the CDC:

In article <513@aecom.UUCP> werner@aecom.UUCP (Craig Werner) writes:
>	Gay men with no history of drug abuse account for 65% of all 
>cases, Gay drug abusers, 8% (total gay = 73%), Heterosexual drug 
>abusers, 17%, Hemophiliacs, 1%, Female Sexual Partners of infected men, 1%,
>and Transfusion associated, 2%.

It may be that Caceres/Krieger use a less restrictive definition of drug
abuse (they "define drug abuse as using a recreational drug at least once
a week").

In any case, I thought the article might be of interest, particularly the
tie between poppers and Kaposi's sarcoma.  The rest of the article is not
AIDS related, but is quite interesting anyway.  I'd recommend getting a
copy of the magazine and reading through it (_American_Health_ is a pretty
swell magazine anyway).

Take care,
 JB

edhall@randvax.UUCP (Ed Hall) (10/23/86)

Repeat after me:

    Correlation does NOT imply causation.
    Correlation does NOT imply causation.
    Correlation does NOT imply causation.

As Barry Shein so aptly pointed out, the correlation between drug
use and AIDS can be explained by a third factor: life-style.

Many--I dare say a majority--of epidemiological studies are flawed by a
failure to rule out all significant confounding factors.  Unfortunately,
it is in the very situation where cooler heads should prevail that
statistical safeguards tend to be forgotten.  And, sad to say, some
otherwise brilliant researchers tend to be ignorant when it comes to the
proper use of statistics, leaving it to others to puzzle out just how
meaningful--or meaningless--the results really are.

		-Ed Hall
		decvax!randvax!edhall
		edhall@rand-unix.ARPA

pete@valid.UUCP (10/24/86)

> 
> Re: article citing high correlation between recreational drug use and AIDS.
> 
> I can't help but immediately wonder if this is in the same realm as
> (we could imagine) a high correlation between breathing air and AIDS.
> 
> I do know that a lot of people who have (sexually transmitted) AIDS
> admit to many sexual partners (over 1000 in a year is not rare.)
> 
> Would it be wild to think that such folks are also predispositioned to
> recreational drug use (especially poppers) and other hedonistic forms
> of self-indulgence?

Speaking anecdotally, most people who inject drugs (the transmittal method for
AIDS by drug users) and share needles don't have near as much interest in sex
as those who don't inject drugs.  Also, most sexual partners of people who
inject and share needles will probably also be drug injectors who share
needles, making a controlled study almost impossible.  It is probably safe to
say that sharing needles is responsible for most of the AIDS transmittal in
the case of those who inject drugs.

By the by, I would tend to refer to people who inject drugs as serious, not
recreational, drug users.  The distinction may be subtle, but I don't think
it is moot.
-- 
-Pete Zakel (..!{hplabs,?}!ridge!valid!pete) (member of HASA)

pete@valid.UUCP (Pete Zakel) (10/25/86)

I have to apologize for my previous posting.  As I am sometimes wont to do, I
posted in response to another posting that was the tail end of something that
I hadn't seen the beginning to.  We just started getting sci.med and I hadn't
been reading net.med, so I posted about AIDS and drugs thinking the discussion
was injection transmittal.  Having seen some other postings I realized that the
discussion was something different, so I therefore submit my apology.
-- 
-Pete Zakel (..!{hplabs,?}!ridge!valid!pete) (member of HASA)