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MICA Populations & HIV

Summer 2000

A note from TheBody.com: Since this article was written, the HIV pandemic has changed, as has our understanding of HIV/AIDS and its treatment. As a result, parts of this article may be outdated. Please keep this in mind, and be sure to visit other parts of our site for more recent information!

MICA is a medical and public health acronym used to describe people who are Mentally Ill Chemically Addicted (or Mentally Ill Chemical Abusers). The number of individuals with mental illness and chemical dependence who are living with HIV has increased exponentially in recent years.



• A 1998 article in the American Journal of Addiction reported 19% HIV sero-positive status in a group of patients with mental illness and substance use. Women were 3.8 times more likely than men to be HIV positive. Cocaine users were 4.5 times more likely than non-users to be positive. • Environmental conditions such as inadequate housing, self-neglect and poor nutrition often accompany substance use, making it difficult for many MICA patients to access quality, long-term medical and psychiatric care in any one location.
• These same conditions can lead to an increased exposure to diseases and a reduced ability to fight off infections. Injection drug use carries higher risk of blood clots, severe skin infections, and blood-borne infections including viral hepatitis and life-threatening endocarditis (inflammation of the lining of the heart and valves), further complicating HIV infection. • Although some societal misconceptions and myths about chemical dependency and mental illnesses are slowly changing, insurance coverage for MICA patients has dropped significantly. An unpublished study by the American Society of Addiction Medicine looked at insurance coverage for employees of medium- to large-sized companies over a ten-year period. The value of coverage for substance abuse treatment declined by 75% between 1988 and 1998 compared with a 52% decline for mental health coverage and a 12% decline for general health care during the same period.
• Psychological and social factors strongly influence MICA patients' dependence on inpatient services. Disjointed ambulatory care and problems in timely coordination and accessibility ultimately lead to deficiencies in preventive care. Delays in the diagnosis of complications of HIV infection often follow. Social isolation further complicates the situation with an increased reliance on hospital emergency rooms and inpatient beds for conditions that might otherwise be managed with adequate family and social support. • The degree of perceptual distortions caused by street drugs on a mentally ill person makes it especially difficult to adhere to complicated drug regimens -- particularly in the absence of support. Too often the result is poor prognosis and premature death.
• Specific components of effective, integrated treatment delivery for MICA patients include harm reduction, stage-wise treatment, motivational interviewing, cognitive behavioral interventions, and modified 12-step self-help groups. • A physician's ability to provide proper pain management to an HIV patient with underlying drug addiction can be a challenge. In order to relieve pain, the physician needs to believe in the patient's pain and understand that tolerance to narcotics may be high.
• MICA patients and their providers face complicated interactions between psychotropics, HIV medications and street drugs. As the liver breaks down the various drugs, levels of one may increase in the body while levels of another may decrease. Protease inhibitors, for example, can raise amphetamine blood levels by as much as three times. At high doses, many sedatives can interact with protease inhibitors and some NNRTIs so as to cause respiratory failure. Protease inhibitors can also increase blood levels of barbiturates like phenobarbitol (Luminal), making overdose more likely. Interactions between cocaine or heroin and antivirals are unknown, but street drugs are rarely pure, and the substances with which they're cut could cause potentially serious interactions with medications. • Some medication side effects can be problematic for people with multiple diagnoses. Videx (ddI) increases the risk of pancreatitis, as does alcohol use. A Videx-containing regimen could be dangerous for a patient who drinks heavily. The central nervous system effects of Sustiva (efavirenz) can include dizziness, mental confusion, feeling lightheaded, forgetfulness and nightmares. Elavil (amitriptyline), often used to treat the painful symptoms of HIV-related or antiviral-induced peripheral neuropathy, can cause feelings of being lightheaded, dulled and groggy. Some MICA patients can have particularly disturbing experiences with either of these medications.



Gopal K. Upadhya, M.D. is Chief Psychiatric Consultant for the Department of Medicine/AIDS Program at The Bronx-Lebanon Hospital Center and an Assistant Professor at Albert Einstein College of Medicine.

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A note from TheBody.com: Since this article was written, the HIV pandemic has changed, as has our understanding of HIV/AIDS and its treatment. As a result, parts of this article may be outdated. Please keep this in mind, and be sure to visit other parts of our site for more recent information!



  
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This article was provided by AIDS Community Research Initiative of America. It is a part of the publication CRIA Update. Visit ACRIA's website to find out more about their activities, publications and services.
 
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