Nav: Home

The relationship between drug injection risk behaviors and immune activation

April 13, 2017

The use of heroin and other illicit drugs has been shown to trigger a response from the body's immune system. Consequently, high levels of immune activation (inflammation) -- that is associated with the progression of chronic disease and disability -- are frequently found among people who inject drugs (PWID).

In an effort to promote better health outcomes for PWID, investigators, working in a three-institution multidisciplinary team, examined the relationship between injection drug use and immune activation in a sample of HIV infected and uninfected PWID. The team, led by Martin Markowitz, MD, Principal Investigator, from the Aaron Diamond AIDS Research Center, conducted a series of studies to assess correlates of immune activation.

"Injection drug use (IDU), with or without HIV-infection, is associated with an increase in immune activation, measured in blood and in the GI tract," says the study's co-investigator, Sauarabh Mehandru, MD, assistant professor, Medicine and Gastroenterology, at the Mount Sinai School of Medicine.

Research participants for the studies included people who were current and former injectors, and comparison participants who never injected. The investigators found the high prevalence of the hepatitis C virus among PWID made it difficult to distinguish between effects of IDU and active HCV infection. To disentangle the effects of injection from HCV infection, the researchers compared immune markers between active PWID and individuals who had ceased injection (for 1-4 months).

"Cessation of injection resulted in a decline in immune activation," notes Dr. Markowitz. "But only in the absence of HCV viremia, i.e., there was no decline in immune activation among those who stopped injecting who were HCV viremic.

The team also examined three risk behaviors: sharing injection equipment; duration of injection frequency in years; and injection frequency over the past 30 days.

"Existing research on the relationship between injection behaviors and immune activation has primarily focused on people who were HIV-infected and yielded inconsistent results," explains co-investigator Sherry Deren, PhD, co-director of CDUHR and a senior research scientist at the NYU Rory Meyers College of Nursing (NYU Meyers). "One contributing factor to these mixed results may be the lack of attention to HCV, which is hyper-endemic worldwide among PWID and was found by our team to be related to immune activation."

However, an examination of the relationship between injection behaviors and immune activation, controlling for HCV viremia, found that while sharing injection equipment was not related to immune activation, frequency of injection and duration of injection were related to the immune markers studied.

The researchers also note that it is possible for HCV-negative PWID to normalize their levels of immune activation by discontinuing injections. The results also suggest that harm reduction efforts to decrease injection frequency, without altogether stopping, can have positive effects towards reducing immune activation.

"Harm reduction efforts for PWID should include treatment of HCV infection, to reduce immune activation and enhance related health benefits," said Dr. Markowitz. "A longitudinal study to test the impact of curing HCV on immune activation among PWID is underway by our group."

The investigators' findings also suggest that efforts to encourage injection cessation or reduction in frequency can have positive health benefits through reducing immune activation.

"Further study to determine the mechanisms of the relationship between injection drug use behaviors and immune activation are needed in order to achieve the comprehensive understanding required to improve health of PWID " conclude the investigators.
-end-
The team's studies:

Deren S, Cleland CM, Lee H, Mehandru S, & Markowitz M (2016) The relationship between injection drug use risk behaviors and markers of immune activation. was recently published in the journal JAIDS Journal of Acquired Immune Deficiency Syndromes. (JAIDS). doi: 10.1097/QAI.0000000000001270.

Markowitz M, Deren S, Cleland C, La Mar M, Silva E, Batista P, St. Bernard L, Gettie N, Rodriguez K, Evering TH, Lee H, & Mehandru S (2016) Chronic hepatitis C infection and the pro-inflammatory effects of injection drug use. Journal of Infectious Diseases.

Mehandru S, Deren S, Kang SY, Banfield A, Garg A, Garmon D, La Mar M, & Markowitz M (2015) Behavioral, mucosal and systemic immune parameters in HIV-infected and uninfected injection drug users. Journal of Addiction Research & Therapy.

Acknowledgments

This research was supported by funds from the National Institute on Drug Abuse (R01DA033777, Markowitz; and P30DA011041, Deren and Hagan). The authors wish to acknowledge the project staff: Evelyn Silva, Pedro Batista, Melissa LaMar, and Sung-Yeon Kang, for their contributions, and to thank all the participating institutions, recruitment sites, and research participants.

We gratefully acknowledge the efforts of the nursing staff at the Rockefeller University Hospital. This work was supported by grants from the National Institutes of Health (NIH) P30 DA011041 (S.D.) and 5R01DA033777 (M.M.) and American Gastroenterology Association (S.M.). Additionally, we would like to acknowledge support from the National Centre for Advancing Translational Sciences (NCATS), NIH Clinical and Translational Science Award (CTSA) program [UL1 TR000043] at the Rockefeller University.

The content is the sole responsibility of the authors and does not necessarily represent the official views of the NIH or any of the organizations involved in this research.

About CDUHR

The mission of the Center for Drug Use and HIV Research (CDUHR) is to end the HIV and HCV epidemics in drug using populations and their communities by conducting transdisciplinary research and disseminating its findings to inform programmatic, policy, and grass roots initiatives at the local, state, national and global levels. CDUHR is a Core Center of Excellence funded by the National Institute on Drug Abuse (Grant #P30 DA011041). It is the first center for the socio-behavioral study of substance use and HIV in the United States and is located at the New York University College of Nursing. For more information, visit http://www.cduhr.org.

New York University

Related Infection Articles:

Male infertility: Urogenital infection as a possible cause
In couples who have not been able to have children, male infertility is the cause in at least half of cases.
A novel approach to seeing dengue infection in the body
Positron emission tomography (PET) paired with the glucose metabolism probe, fluorodeoxyglucose (FDG), is considered 'old' technology in the field of cancer.
Smelling the risk of infection
Humans and monkeys are social beings and benefit from a community.
Tuberculosis and HIV co-infection
The HIV virus increases the potency of the tuberculosis bacterium (Mtb) by affecting a central function of the immune system.
New insight into course and transmission of Zika infection
In one of the first and largest studies of its kind, a research team lead by virologists at Beth Israel Deaconess Medical Center has characterized the progression of two strains of the viral infection.
UTMB researchers protect against lethal Ebola Sudan infection four days after infection
Researchers at The University of Texas Medical Branch at Galveston, in collaboration with Arbutus Biopharma Corporation, have protected nonhuman primates against Ebola Sudan four days following exposure to the virus.
How tumor necrosis factor protects against infection
Tumor necrosis factor (TNF), a messenger substance in the immune system, plays an important role in triggering chronic inflammatory diseases.
Gene amplification -- the fast track to infection
Researchers at UmeƄ University in Sweden are first to discover that bacteria can multiply disease-inducing genes which are needed to rapidly cause infection.
New test allows for one-step diagnosis of HCV infection
The current standard in diagnosing Hepatitis C virus (HCV) infection requires two sequential steps that make it suboptimal, costly, inconvenient, time consuming, and globally not widely available or affordable.
Do dressings prevent infection?
There is insufficient evidence to know whether dressings reduce the risk of wound infection after surgery and, in some cases, leaving a wound exposed may be better, say researchers in The BMJ today.

Related Infection Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Anthropomorphic
Do animals grieve? Do they have language or consciousness? For a long time, scientists resisted the urge to look for human qualities in animals. This hour, TED speakers explore how that is changing. Guests include biological anthropologist Barbara King, dolphin researcher Denise Herzing, primatologist Frans de Waal, and ecologist Carl Safina.
Now Playing: Science for the People

#SB2 2019 Science Birthday Minisode: Mary Golda Ross
Our second annual Science Birthday is here, and this year we celebrate the wonderful Mary Golda Ross, born 9 August 1908. She died in 2008 at age 99, but left a lasting mark on the science of rocketry and space exploration as an early woman in engineering, and one of the first Native Americans in engineering. Join Rachelle and Bethany for this very special birthday minisode celebrating Mary and her achievements. Thanks to our Patreons who make this show possible! Read more about Mary G. Ross: Interview with Mary Ross on Lash Publications International, by Laurel Sheppard Meet Mary Golda...