Human immunodeficiency virus infection and other risk factors for skin abscesses and endocarditis among injection drug users

Abstract

Objective: to study incidence rates of and risk factors for skin abscesses at the site of injection and episodes of endocarditis among injection drug users (IDU). Design: A comprehensive, open cohort study of drug users on the natural history of human immunodeficiency virus (HIV) infection. Methods: From 1986 to 1994, injection drug users in Amsterdam were included in the study. Incidence rates of self-reported skin abscesses and verified episodes of endocarditis were calculated. In uni- and multivariate Poisson regression analysis, risk factors for skin abscesses and endocarditis were determined. Results: 521 HIV-seronegative and 237 HIV-seropositive IDU were followed for 1640 person-years. A total of 545 skin abscesses were reported by 269 IDU (incidence 33/100 person-years). HIV infection, female gender, prostitution among females, foreign nationality, injection of heroin and cocaine, a high frequency of injecting, and obtaining syringes through the needle exchange program were independently and positively associated with skin abscesses. During follow-up, 17 verified episodes of endocarditis were observed (incidence 1.3 100 personyears). Endocarditis was independently associated with HIV infection and a previous history of endocarditis. Furthermore, women and IDU with a skin abscess appeared to be at an increased risk for endocarditis. Conclusions: HIV infection is an independent risk factor for skin abscesses and endocarditis. Also, women are at an increased risk for these injection-related infections. Prevention activities, like promotion of skin cleaning, should be directed at those IDU in whom one or more risk factors have been identified.