Effects of Drugs on severe infection & Drug abuse
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 paper 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.
Sociopolitical, economic, and health costs to the society from substance abuse and infections are enormous. Legal and illegal substance abuse alone costs the American society an estimated one-half a trillion dollars annually, while diabetes and cancer cost an estimated $132 billion and $219 billion, respectively. Both drugs of abuse and infections such as HIV and HCV affect almost every physiological/biochemical system in the body. Thus, health effects may range between neuropsychiatric complications, anxiety and depressive disorders, cardiomyopathies, immune impairment, metabolic/endocrine disorders (lipodystrophy), and hepatic failure, to name a few. Because this subject of health consequences of drugs of abuse and infections is very wide and could not be covered in a mini-symposium at this ISAM conference, we decided to present only three aspects of consequences- a brief review of medical consequences in general, psychiatric conditions complicating hepatitis C infection in drug addicts.
In general, stimulants such as cocaine and methamphetamine (‘met’, ‘speed’, or ‘ice’) increase the heart rate while constricting the blood vessels; in susceptible individuals, these two actions together set the stage for cardiac arrhythmias and strokes. Methamphetamine also causes serious hyperthermia, increases wakefulness and physical activity, creating the potential for a combination of activity and overheating that leads to convulsions and dangerous, sometimes lethal elevation of body temperature. Cocaine use decreases the blood flow to the brain, increases the heart rate, and elevates the blood components that promote clotting—effects that can lead to stroke or heart attack even in those not otherwise at risk for these serious cardiovascular events.
In summary, drug abuse and infections such as HIV and HCV are associated with a wide variety of medical and health consequences including neuropsychiatric complications such as anxiety disorders, severe depression, and suicidal attempts. Although treatment of drug addiction and dual infections of HIV and HCV is complex, it is achievable with integrated programs of health care for dually infected drug addicts. The problem of drug interactions that appeared between HIV antiretrovirals and methadone seems to be less with the newly approved buprenorphine. Future research will show whether similar interactions would occur between buprenorphine or methadone and newer drugs that are being developed for the treatment of HIV and HCV. It is also anticipated that the newer antiretroviral medications would have lesser neuropsychiatric complications or pharmacokinetic interactions.
Journal of Infectious Diseases and Diagnosis