'Brown sugar' heroin intoxication and improvement of surrogate immunologic markers in HIV infection.
OBJECTIVE: To report on the unexpected improvement in major biological surrogate markers (CD4 T-cell count, HIV RNA viral load, and apoptosis level) during the periods of 'brown sugar' heroin intoxication (BSI) in 12 HIV-1-infected intravenous drug users, independently of their antiretroviral therapy, compared to the period of 'brown sugar' heroin withdrawal (BSW). METHODS: The patients were followed prospectively for a total of 417 months over 4 years. Twenty-four episodes of BSI and 24 periods of BSW were analyzed. RESULTS: (1) BSI: the mean (+/-SE) duration was 9+/-1.8 months; at onset, the mean +/-SE CD4 T-cell count was 401+/-88/mm3; at the end, an absolute increase of 346 CD4 T-cells/mm3 and a CD4 T-cell count relative variation of +131% was observed. Half of the patients showed an increase of CD4 T-cell count of more than 90% during their follow-up. The mean+/-SE of CD8 T-cell count increased significantly by 108%. (2) BSW: the mean +/- SE duration was 8.4+/-1.3 months; at onset, the mean +/-SE CD4 T-cell count was 695+/-78/mm3; at the end, an absolute decrease of 342 CD4 T-cells/mm3 and a CD4 T-cell count relative variation of -52% was observed. Half of the patients showed a decrease of CD4 T-cell count of more than 51%. (3) Circulating viral load appeared to be significantly higher during BSW (median: 452 000 Eq RNA/mL) than during BSI (median: 52 000 Eq RNA/mL); p<0.01. (4) Similarly, the apoptotic process affecting circulating lymphocytes was significantly lower during BSI than during BSW episodes. (5) The 4-year mortality rate was 7%, compared with 36% in HIV-positive former drug users (p<0.001). CONCLUSIONS: Taken together, these features suggest that 'brown sugar' heroin could have either immunomodulatory or antiretroviral properties. Confirmation of these findings and investigation of the role of the many substances in 'brown sugar' heroin are indicated.
Prazuck
T.
T
Departement des Maladies Infectieuses, Centre Hospitalier Regional, Orléans.
Malkin
J.E.
JE
Belec
L.
L
Chamaret
S.
S
Semaille
C.
C
Alcais
A.
A
Lafaix
C.
C