Donahoe R M, Vlahov D
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Georgia Mental Health Institute, Atlanta 30322, USA.
J Neuroimmunol. 1998 Mar 15;83(1-2):77-87. doi: 10.1016/s0165-5728(97)00224-5.
Because of the widely documented association of AIDS with opiate abuse, there is considerable interest in knowing whether opiates alter progression of HIV-1 infections to AIDS. The main reason for this interest is that opiates and opiate-abuse have been shown to have broad influence on immune processes as well as in vitro expressions of HIV-1. This article reviews literature defining the connection between opiate use and AIDS. Basic understanding of the effects of opiates on immune process and HIV-1 infection, especially as derived from study of a monkey model of AIDS, are discussed as well as epidemiological data regarding the connection between chronic injected drug abuse and AIDS, in the context of current knowledge about the HIV-1 infectious process and AIDS pathogenesis. Theoretically, there is ample reason to suspect that opiates are involved in progression of HIV-1 infections to AIDS. To date, however, epidemiological approaches have been unable to link decline in CD4 T-cell counts, as a marker of AIDS progression, with opiate use--although other indices of AIDS progression have yet to be thoroughly evaluated in this regard. Also, the impact of opiate use and abuse on opportunistic infections occurring prior to or concurrent with HIV-1 infection has not been closely scrutinized. Interestingly, despite considerable evidence delineating the potential of opiates to exacerbate HIV-1 infections, there is suggestive evidence from both clinical observations and basic studies that homeostatically balancing conditions of chronic, consistent opiate exposure have the potential to protect the host from progression of HIV-1 infections--a situation that may well differ from when opiate-naive subjects first experience exposure to opiates and when opiate dependency is not maintained in a consistent fashion. Taken together, therefore, information from basic studies, including most particularly studies with monkeys, and epidemiological studies, indicates that effects of opiates on progression to AIDS may be conditionally variable. There are many aspects of the drug abuse culture that have potentially offsetting consequences in terms of their potential to up- or down-regulate both HIV-1 expression and host protective responses thereto that could be relevant in this regard. In conclusion, many ambiguities are yet to be considered, and basic and epidemiological studies to be pursued before the opiate-AIDS connection is fully understood.
由于艾滋病与阿片类药物滥用之间的关联已有广泛记载，因此人们非常关注阿片类药物是否会改变HIV-1感染向艾滋病的发展进程。产生这种关注的主要原因是，阿片类药物和阿片类药物滥用已被证明对免疫过程以及HIV-1的体外表达有广泛影响。本文回顾了界定阿片类药物使用与艾滋病之间联系的文献。讨论了对阿片类药物对免疫过程和HIV-1感染影响的基本理解，特别是从艾滋病猴模型研究中得出的理解，以及在当前关于HIV-1感染过程和艾滋病发病机制的知识背景下，关于慢性注射吸毒与艾滋病之间联系的流行病学数据。从理论上讲，有充分理由怀疑阿片类药物与HIV-1感染向艾滋病的发展有关。然而，迄今为止，流行病学方法尚未能够将作为艾滋病进展标志的CD4 T细胞计数下降与阿片类药物使用联系起来——尽管在这方面艾滋病进展的其他指标尚未得到充分评估。此外，阿片类药物使用和滥用对HIV-1感染之前或同时发生的机会性感染的影响尚未得到仔细审查。有趣的是，尽管有大量证据表明阿片类药物有加剧HIV-1感染的潜力，但临床观察和基础研究都有提示性证据表明，慢性、持续阿片类药物暴露的内稳态平衡状态有可能保护宿主免受HIV-1感染的进展——这种情况可能与从未接触过阿片类药物的受试者首次接触阿片类药物时以及阿片类药物依赖未以一致方式维持时的情况大不相同。因此，综合基础研究（尤其是猴子研究）和流行病学研究的信息表明，阿片类药物对艾滋病进展的影响可能因条件而异。药物滥用文化的许多方面在其上调或下调HIV-1表达及其宿主保护性反应的潜力方面可能产生抵消性后果，这在这方面可能是相关的。总之，在充分理解阿片类药物与艾滋病的联系之前，还有许多模糊之处有待考虑，需要进行基础研究和流行病学研究。
