Effect of Heroin Use on Immune Activation and Cardiovascular Risk in HIV

This is a 48-week matched, prospective, observational, cohort study of HIV-infected adults on antiretroviral therapy who actively use heroin or who have never used heroin. The overarching goals are 1) to define the extent and specifics of immune activation in HIV-infected IV heroin users; 2) to define the effect of IV heroin on gut integrity and permeability, and the relationship of gut integrity alteration and immune activation; 3) importantly, to study the reversibility of immune activation, inflammation, and gut dysfunction after cessation of IV heroin, and to that effect, compare strategies for medication assisted treatment-buprenorphine/naloxone versus methadone or vivitrol maintenance; 4) to study if heightened immune activation associated with active intravenous drug use (IVDU) is associated with higher cardiovascular disease risk, including endothelial dysfunction and arterial inflammation, and if these effects are reversible with buprenorphine/naloxone or methadone.

Inclusion criteria

• HIV infection or no HIV infection
• 18 years or older
• HIV-1 RNA < 400 if HIV-infected and on antiretroviral therapy
• On stable antiretroviral therapy at least 12 weeks with cumulative duration of at least a year for HIV-infected if on antiretroviral therapy
• Currently using heroin at least 1 month with a cumulative duration of at least 12 months in the past for active heroin group
• Initiating medication assisted treatment for active heroin use initiating medication assisted treatment groups

Exclusion criteria

• Active infection, malignancy or other inflammatory condition
• Uncontrolled diabetes or hypothyroidism
• Known cardiovascular disease
• Pregnancy