Heart disease, methamphetamine and AIDS

Abstract

Methamphetamine (MA) not only affects the nervous system but also has cardiac toxicity and immunosuppressive properties. This manuscript will provide support that there is a relationship between MA use and heart disease as well as immune dysfunction. The cardiovascular manifestations of acute MA use include tachycardia, atrioventricular arrhythmias, myocardial ischemia, myocardial ischemia and hypertension, resulting in cardiac lesions. Chronic use of MA causes cardiomyopathy including cellular infiltration, myocardial hypertrophy, myocardium rupture and fibrosis. The increased catecholamine levels are responsible for the cardiac lesions induced by MA. The additional problem with MA use is its potential to disrupt the immune system function leading to suppression of mitogen-stimulated lymphocyte, a reduction in circulating lymphocyte numbers and alternation T-lymphocyte cytokine secretion as well as B cell proinflammatory cytokine secretion. Concomitant MA use and Human Immunodeficiency Virus (HIV) infection not only enhances immunosuppression associated with HIV but also increases the heart disease occurrence with a coincidentally complication of AIDS or AIDS medications.

Introduction

Methamphetamine (MA) also known as speed, crank, go, crystal, meth, ICE or poor man's cocaine, is a derivative of amphetamine. Amphetamine including MA has a similar structure to a natural extract, ephedrine, a sympathomimetic amine used as a stimulant and possessing appetite suppression and bronchodilation properties. (MacKenzie and Heischober, 1997) MA was first synthesized by a German chemist in 1887, studied extensively, and used in the clinic until 1930s. (Anglin et al., 2000) Subsequently, MA was widely available for users and caused abuse epidemic that occurred rapidly. In the 1960s, the United States government realized that MA has significant potential of tolerance and physiologic dependence. Therefore in 1970, MA was restricted as a controlled substance by government law. MA is easily made in clandestine home laboratories by reduction of ephedrine or by the condensation of the phenylacetone and methylamine. MA is less expensive compared to cocaine and has become the most common illicit abused amine drug, resulting in rapidly increased users number. In 1996, about 2.3% of the population had used MA at least once in the United States and this epidemic also greatly spread world-widely such as Asian countries. The National Institute on Drug Abuse, 2002, NIDA Research Report, 2002.

MA as a sympothemimic stimulant affects the central nervous system (CNS). MA use leads to rapid rise in blood levels generating a quick and long lasting high resulting in intense euphoria and addictive potential. (Centers for Disease Control and Prevention, 1995) MA can be taken orally, snorted, smoked or injected, in approximately increasing order of immediacy of onset. Duration is subjective, but is probably on the order of 4–8 hours. Delayed absorption (for example, due to oral ingestion) can prolong the effects relative to time of administration. Of course, larger doses last longer due to the fact that it is removed from the blood at a finite rate. The serious side effects of MA use include neurologic, obstetric, gastrointestinal, renal, endocrine complications, with possible long-term damage and cardiovascular disease, which is the most common complaint by MA users. (Derlet and Horowitz, 1995) MA abuse is also a social problem related to crime, traffic and non-traffic accidents, physical and psychological hazards. In California, MA-related hospital admissions increased 49% in 1994 compared to 1993. In Iowa, MA use accounted for 65% drug arrests, even more than alcohol arrests. (US Department of Justice-Drug Enforcement Administration, 1996) In 1999, the American Association of Poison Control Centers' (AAPCC) Toxic Exposure Surveillance System did not categorize specific methamphetamine exposures; these exposures were included in the amphetamine category. A total of 16,684 exposures were reported, with 4593 in those younger than 6 years and 4614 in those older than 19 years. During 1999, a total of 18 deaths associated with amphetamine exposures were reported to the AAPCC. Frequently, many local coroners' offices have more reliable data on fatalities associated with street-drug abuse. More seriously, MA acute overdose or chronic use has high death rate. A 5-year retrospective investigation in Japan revealed that 2.32% victims of drug use were MA-related in the drug-related death cases. (Zhu et al., 2000) In Greece, until 1997, only one MA-related fatality case was reported, while from 1997 to 2002, there were 7 out 1500 fatalities. (Raikos et al., 2002) MA use is also highly related to HIV infection and AIDS development. Rotheram-Borus et al., 1994, Molitor et al., 1998.

Thus, understanding the mechanisms, pathogenesis and effects of MA use and HIV infection on heart disease will help define therapeutic targets and avenues of prevention for these MA users, AIDS and heart disease patients.