Levamisole-Contaminated Cocaine Use in HIV-Infected and Uninfected Unstably Housed Women.
Levamisole-Contaminated Cocaine Use in HIV-Infected and Uninfected Unstably Housed Women.
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感染艾滋病毒和未感染艾滋病毒、居住不稳定的妇女使用左旋咪唑污染的可卡因。
DOI：
10.1089/jwh.2015.5532
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发表时间：
2016
期刊：
影响因子：
--
通讯作者：
Lynch,KaraL
中科院分区：
文献类型：
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作者：
Riley,EliseD;Kral,AlexH;Cohen,Jennifer;Dilworth,SamanthaE;Shumway,Martha;Lynch,KaraL
越来越多的病例报告提到与可卡因掺假物有关的严重健康并发症，左旋咪唑和妇女受到不成比例的影响;然而，临床效果尚未得到充分证实。在2010年4月至10月期间，我们对222名无家可归和住房不稳定的妇女（116名人类免疫缺陷病毒[HIV]感染者和106名未感染者）进行了横断面研究。通过可卡因和左旋咪唑暴露在不同的模型中比较免疫标记物和行为因素。总体而言，63%的参与者可卡因/苯甲酰基爱贡碱毒理学检测呈阳性，其中85%的参与者左旋咪唑检测也呈阳性。免疫标志物的差异在未感染艾滋病毒的人群中没有达到显著水平。与可卡因和左旋咪唑均阴性的HIV感染者相比，两者均阳性的HIV感染者中低白色血细胞计数的调整后几率显著较高（p = 0.03），但仅可卡因阳性的HIV感染者中则无此差异。在HIV感染者中，可卡因和左旋咪唑状态对中性粒细胞计数和HIV病毒载量没有影响。在一个单独的模型中，与白人和亚洲女性相比，非裔美国女性中左旋咪唑检测阳性的调整几率更高（p = 0.02）。在左旋咪唑流行率高的背景下，结果表明，由于左旋咪唑暴露而导致的免疫功能下降主要发生在已经免疫受损的个体中（例如，艾滋病毒阳性），种族/民族似乎是了解可卡因使用妇女中左旋咪唑暴露的一个重要因素。虽然需要更大规模和地理上多样化的研究来阐明这些初步发现，但结果表明左旋咪唑可能是使用可卡因的HIV感染妇女免疫功能障碍的一种机制。
A growing number of case reports cite serious health complications linked to the cocaine adulterant, levamisole and women are disproportionately affected; however, the clinical effects are not well established. Between April and October of 2010, we conducted a cross-sectional study among 222 homeless and unstably housed women (116 human immunodeficiency virus [HIV]-infected and 106 HIV-uninfected). Immune markers and behavioral factors were compared in separate models by cocaine and levamisole exposure. Overall, 63% of participants were toxicology positive for cocaine/benzoylecgonine, 85% of whom also tested positive for levamisole. Differences in immune markers did not reach levels of significance among HIV-uninfected persons. Compared to HIV-infected persons who were negative for both cocaine and levamisole, the adjusted odds of low white blood cell count were significantly higher among HIV-infected persons positive for both (p= 0.03), but not for those positive for cocaine only. Neutrophil count and HIV viral load did not differ by cocaine and levamisole status among HIV-infected persons. In a separate model, the adjusted odds of testing positive for levamisole were higher among African American women compared to Caucasian and Asian women (p= 0.02). In the context of high levamisole prevalence, results suggest that decreased immune function as a result of levamisole exposure occurs mainly in individuals who are already immune compromised (e.g., HIV-positive), and race/ethnicity appears to be an important factor in understanding levamisole exposure among cocaine-using women. While larger and geographically diverse studies are needed to elucidate these initial findings, results suggest that levamisole may be one mechanism of immune dysfunction in HIV-infected cocaine-using women.