The progression of HIV varies

The progression of HIV varies from patient to patient, with some who progress slowly and others who progress much faster. However, CD4+ and CD8+ cell counts are intimately linked in those that are able to suppress the HIV infection (Walker et al., 1986; Saez-Aninon et al., 2007). Depletion of these markers is associated with increased HIV progression, inflammation, and potentially other end organ complications (Deeks, 2011). The increases in inflammation are critical, as the inflammatory markers are potentially recruiting other immune NLG919 to their death (Doitsh et al., 2014). The decrease in the inflammatory response in marijuana users may account for the increase in HIV-related immune markers, as marijuana usage may attenuate this cycle of HIV-related cell pyroptosis. This notion is in line with previous animal models, which suggest that marijuana may mitigate the transference of the virus from one cell to the next (Molina et al., 2011a). The findings from the current study support this literature, as those who tested positive for marijuana use have higher CD4+ and CD8+ counts than their negative counterparts.
Contributors
Conflict of interest
Introduction Rural, low HIV prevalence settings in the United States are increasingly vulnerable to new HIV transmissions because of epidemic levels of opioid use and increasing prevalence of injection opioid use [1], [2]. Opioid misuse and injection are particularly problematic in West Virginia, where in 2017, there were 49.6 opioid overdose deaths per 100,000 persons, the highest rate in the country [3]. Opioids are increasingly injected in West Virginia as in other parts of the rural United States [4], [5], [6]; as an indication, the rate of acute Hepatitis C in West Virginia was more than five times the national average in 2016 [7]. Aiming to prevent increases in HIV infections caused by unsafe injection opioid use following a well-documented outbreak in Scott County, Indiana [8], the Centers for Disease Control and Prevention (CDC) created a “vulnerability index” to identify counties at high risk for rapid HIV dissemination due to injection drug use. Over half (51%) of West Virginia's 55 counties were listed in the top 5% of the country's most vulnerable counties [2]. During the first three-quarters of 2017, amid heightened awareness of the opioid crisis, the West Virginia Department of Health and Human Resources (WV DHHR) identified 40 persons with recently diagnosed HIV in 15 geographically contiguous counties. By October, the number of HIV diagnoses in these counties had surpassed year-end totals for 2015 and 2016 [9]. Nearly all 15 counties were among the most vulnerable to rapid HIV dissemination in the country, according to CDC's index [2]. Concerns about the possibility of an HIV outbreak like the one that occurred in Indiana prompted further investigation of persons with HIV diagnosed in 2017. According to reported lifetime risk from West Virginia surveillance data, most (60%) people with HIV diagnosed in 2017 likely acquired HIV through male-to-male sexual contact, 9% likely acquired HIV through injection drug use (IDU), and an additional 5% through either male-to-male sexual contact or IDU [9]. However, data on current IDU behaviors of contacts were unavailable. To assess potential for further increases in HIV infections in this area, we conducted a network investigation to assess sexual and IDU risk among persons with HIV diagnosed in 2017 and their contacts. Specifically, we aimed to determine whether bridging of HIV risk was occurring between men who have sex with men (MSM) and one or more networks of persons who inject drugs (PWID). Bridging is defined for the purpose of this analysis as shared HIV transmission risk from a population with one primary HIV risk factor to a population with another primary risk factor through people exhibiting both risk factors.
Materials and methods