[Final Program, International Conference on AIDS (4th: 1988: Stockholm, Sweden), Book 2]

8545 ABNORMAL LYMPHOCYTE SUBSETS AND NATURAL
KILLER CELL FUNCTION IN ANTI-HIV NEGATIVE
INTRAVENOUS DRUG USERS ON METHADONE. N. Klimas*+.
N. Blaney*, R. Morgan*, M. Ashman*, M. Fletcher*
*Univ. of Miami Biopsychosocial Center for AIDS Research
+Veterans Administration Medical Center, Miami, Florida
Objective: To determine lymphocyte subsets, including
activation markers and subsets of CD4; natural killer
cell (NK) cytotoxicity; and NK kinetic activity in HIVIVDA methadone patients.
Methods: 22 HIV- (by ELISA and western blot) IVDA and 72
normal controls were studied. Activation markers and CD4
subsets were determined by two color flow cytometry; NK
cytotoxicity was assayed to the K562 cell line.
Results: The CD4+/2H4+ subset, inducers of CD8+ cells,
was below normal(p<.001). The CD4+/4B4+ subset,
inducers of soluble antigen response, was elevated over
normals (p<.001). Concurrently CD8 cells expressed
activation of class 2 antigen (I2+/CD8+, p<.001) and
expressed activation of CD2+ by the alternate pathway,
with elevation of TA1+/T11+ subset (p<.001). %NKH1 cells
were elevated (p<.001), though NK cytotoxicity was low
(p<.001), with KLU/4H depressed (p<.001), showing that
despite elevated numbers, the NK cells did not lyse
targets efficiently.
Conclusions: The low 2H4+/CD4+ subset and high 4B4+/CD4+
subset suggest active stimulation of the cells
responsible for immunoglobulin synthesis, with a low
induction of down regulating suppressor cells, promoting
the polyclonal activation seen in this risk group. The
elevated I2+/CD8+ and TA1+/CD2+ subsets, as well as the
poor NK cell function despite elevated numbers,
contribute to the accumulating evidence of regulatory
dysfunction in this HIV- risk group.

8546 METHADONE MAINTENANCE TREATMENT (MMTP) AND
REDUCED RISK OF AIDS AND AIDS-SPECIFIC
MORTALITY IN INTRAVENOUS DRUG USERS (IVDUs)
Diana Hartel, Peter A. Selwyn, EE Schoenbaum, RS Klein,
GH Friedland. Montefiore Medical Center/Albert
Einstein College of Medicine, Bronx, New York, USA.
Objective. To determine the association between entry
into MMTP, AIDS, and mortality in IVDUs.
Methods. An historical prospective study was conducted
of 995 patients entering a Bronx MMTP from 1978-87 who
either remained enrolled or died in treatment during a
surveillance period from 1/1/84-12/31/87. Subjects were
grouped into entry year cohorts. Surveillance data on
AIDS diagnoses and deaths were analyzed using life table
and regression methods which controlled for age, race,
gender, entry selection factors and length of treatment.
For a subgroup of patients (n=362) enrolled since 1985 in
an HIV seroprevalence/longitudinal study, the association
between MMTP entry and HIV antibody (Ab) status was examined. Incidence rates were calculated in person-years.
Results. Cohorts entering MMTP before 1983 had lower AIDS
incidence (11.4/1000 person-yrs.) and AIDS death rates.
(8.7/1000) than later entrants (33.0/1000, 20.5/1000,
p(.05), but overall death rates did not differ significantly
(26.8/1000 vs. 38.9/1000, p=NS). Whites had lower AIDS incidence than nonwhites (12.2/1000 vs. 25.1/1000, p(.05),
and whites tended to enter MMTP earlier and remained in
treatment longer than nonwhites (p(.01). However, by regression analysis, the year of MMTP entry was a stronger
predictor of AIDS and AIDS-specific mortality (OR adjusted
=2.6, p(.05) than race (OR=1.1, p=NS). Seroprevalence
study data indicated an inverse relationship between HIV
seropositivity and duration of MMTP treatment (p(.03).
Conclusion. Entry into MMTP before 1983 was associated with
lower AIDS incidence and AIDS-specific mortality among IVDUs
even after controlling for other variables. Data suggest
that MMTP is associated with reduced risk of HIV infection
and AIDS, and may have a protective role in populations of
IVDUs still uninfected with HIV.

Notes:

8547 INNOVATIVE AIDS RISK REDUCTION PROJECT:
INTERIM METHADONE CLINIC
S.Yancovitz*, D.Des Jarlais**, N.Peyser*,
R.Senie*, E.Drew*, D.Mildvan*, et al.
*Beth Israel Medical Center, New York, NY
**NYS Division of Substance Abuse Services, N.Y.,N.Y.
Objective: To study the impact of methadone on reducing
AIDS risk activities among IVDAs.
Methods: IVDAs on a waiting list for comprehensive methadone treatment (MMTP) were interviewed about drug use,
AIDS risk behavior, and quality of life. All received
AIDS education but not drug abuse counseling. Consenting
subjects were randomly assigned to: A-Daily methadone,
biweekly urine toxicology and interview; B-No methadone,
biweekly urine toxicology and interview; C-No methadone,
no follow-up until entry into MMTP.
Results: During the study, Group C was eliminated due to
the reluctance of subjects to participate with only 1 in
3 chances of receiving methadone. Data on 209 subjects
were analyzed. Baseline needle use averaged 95 times/month
for both groups. At followup, 33% of those in A reported
nedle use vs. 87% of B, a significant difference (p<.01).
Urines show continued use of cocaine by both groups, but
those in A were more likely to report non-IV routes of
administration. Quality of life scores improved in both
groups, but the mean for A was significantly higher than
B. Multivariate analysis shows needle use significantly
associated with treatment group, quality of life score,
and employment. No untoward events occurred.
Conclusion: The interim methadone clinic provides an
effective, safe intervention in AIDS risk behavior for
IVDAs awaiting openings in comprehensive MMTP. Problems
with Control Group C have important implications for
future studies in the IVDA population.

8548 AIDS AND IV HEROIN ADDICTS: THE PREVENTIVE
EFFECT OF METHDONE MAINTENANCE IN SWEDEN.
Olof Blix, M.D. L. GrOnbladh, B.A.
University of Uppsala, Psychiatric Research Center,
Ulleraker Hospital, S-750 17 Uppsala, Sweden
Objective. To describe the Swedish Methadone Maintenance
Program (MMP) and its impact on the prevalence of HIV
infection among cases admitted before and after the outbreak on AIDS epidemic.
Methods. Patients admitted to the MMP before 1983 were
tested and retested for the prevalence of HIV antibodies during 1985-1987. Patients admitted 1984 and
later were tested upon admission and retested during
subsequent treatment. Old admissions (before 1983) are
compared to admissions 1984-86 and 1987.
Results. Our findings are shown in the following table:

Admission yr n
Before 1983 67
1984-86 32
1987 6C

HIV+ Unknown

HIV+ %

2
5
34

2* 3
-16
-57

* Refused the test
So far, no case of seroconversion from negative to positive has occurred among patients who tested negative
upon admission since 1984 and were still in program
December 1987.
Conclusions. The HIV epidemic first hit the Swedish i.v.
heroin addicts in 1983. Our findings strongly suggest
that methadone maintenance is effective in preventing
treated patients from contracting HIV.

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