Group Of Injecting Drug Users Research Articles

Features of infective endocarditis in injection drug users

Aim . To reveal the peculiarities of clinical manifestations of infectious endocarditis in injection drug addicts. Material and methods . Clinical, laboratory, echocardiographic manifestations of infectious endocarditis in 40 injecting drug addicts and in 21 patients of control group were analysed. Among injection drug users there were 22 men aged 40,0±2,9 years and 18 women aged 29,5±2,3 years. The history of the disease, clinical manifestations, laboratory markers of inflammation, the results of bacteriological blood tests, and the dynamics of the state during therapy were analyzed. Echocardiography at admission to hospital and at the end of treatment was carried out on a Vivid E-9 apparatus using transthoracic and transesophageal probes. The electrocardiogram was recorded in 12 standard leads. All patients underwent an x-ray examination of thoracic organs or multispiral pulmonary tomography, ultrasound of the liver and spleen. Statistical analysis of the research results was conducted using Statistica 7.0, Microsoft Office Excel. Results . We determined significantly younger age of patients in the group of injection drug users (p<0,05). The most frequently detected manifestation of infective endocarditis in both groups was fever. According to echocardiography data, tricuspid valve isolated localization of endocarditis was found in 90%. Radiographically, 8,2% of drug-dependent patients had signs of pneumonia (often bilateral multisegmental), regarded as a manifestation of the thromboembolic syndrome by vegetation particles. Splenomegaly (75%) was detected in the majority of drug addicts, less often — hepatomegaly (47,5%). Manifestations of chronic heart failure were detected only in 12,5% of patients who use drugs, the kidneys were less involved in the process. An association of infective endocarditis with HIV infection (72,5%) and hepatitis C was detected in 97,5% of patients. Conclusion . Knowing of the infective endocarditis features in drug addicts makes it possible to improve the approaches to the diagnostics in earlier periods of its progression and thus makes the treatment of these patients more promising.

Predominance of CRF63_02A1 and multiple patterns of unique recombinant forms of CRF63_A1 among individuals with newly diagnosed HIV-1 infection in Kemerovo Oblast, Russia.

Kemerovo Oblast (KO) has had the highest rate of HIV spread in Russia since 2011. The aim of this work was to study the genetic variation of HIV-1 in Kemerovo Oblast. Blood was sampled from a total of 91 HIV-positive antiretroviral-therapy-naïve individuals in 2013 (38) and 2015 (53). HIV-1 subtypes, pol gene drug resistance mutations, and viral tropism were analyzed. In 2013-2015, the prevalence of HIV-1 subtype A decreased in KO from 60.5 to 7.5%. The samples collectedin2015 from the patients with newly diagnosed HIVdemonstrate the current dominance of HIV-1 CRF63_02A1 (71.7%) and HIV-1 URF63_A1 (20.8%), their parentalviruses being CRF63_02A1 and subtype A. The initially predominant genetic variant, HIV-1 subtype A, was replaced in KO. An unusually high incidence of HIV-1 unique recombinant forms is probably the result of HIV-1 CRF63_02A1 introduction in the group of injection drug users with the initial HIV-1 subtype A infection and the practice of risky behavior that promotes reinfection. HIV-1 CRF63_02A1, which recently emerged in Siberia, and its recombinant forms have an ever-increasing impact on the current HIV epidemic in Russia, making urgent the need for in-depth study of this HIV-1 genetic variant.

Humoral Dysregulation Associated with Increased Systemic Inflammation among Injection Heroin Users.

BackgroundInjection drug use is a growing major public health concern. Injection drug users (IDUs) have a higher incidence of co-morbidities including HIV, Hepatitis, and other infections. An effective humoral response is critical for optimal homeostasis and protection from infection; however, the impact of injection heroin use on humoral immunity is poorly understood. We hypothesized that IDUs have altered B cell and antibody profiles.Methods and FindingsA comprehensive systems biology-based cross-sectional assessment of 130 peripheral blood B cell flow cytometry- and plasma- based features was performed on HIV-/Hepatitis C-, active heroin IDUs who participated in a syringe exchange program (n = 19) and healthy control subjects (n = 19). The IDU group had substantial polydrug use, with 89% reporting cocaine injection within the preceding month. IDUs exhibited a significant, 2-fold increase in total B cells compared to healthy subjects, which was associated with increased activated B cell subsets. Although plasma total IgG titers were similar between groups, IDUs had significantly higher IgG3 and IgG4, suggestive of chronic B cell activation. Total IgM was also increased in IDUs, as well as HIV Envelope-specific IgM, suggestive of increased HIV exposure. IDUs exhibited numerous features suggestive of systemic inflammation, including significantly increased plasma sCD40L, TNF-α, TGF-α, IL-8, and ceramide metabolites. Machine learning multivariate analysis distilled a set of 10 features that classified samples based on group with absolute accuracy.ConclusionsThese results demonstrate broad alterations in the steady-state humoral profile of IDUs that are associated with increased systemic inflammation. Such dysregulation may impact the ability of IDUs to generate optimal responses to vaccination and infection, or lead to increased risk for inflammation-related co-morbidities, and should be considered when developing immune-based interventions for this growing population.

The Significance of Harm Reduction as a Social and Health Care Intervention for Injecting Drug Users: An Exploratory Study of a Needle Exchange Program in Fresno, California

Infectious disease remains a significant social and health concern in the United States. Preventing more people from contracting HIV/AIDS or Hepatitis C (HCV), requires a complex understanding of the interconnection between the biomedical and social dimensions of infectious disease. Opiate addiction in the US has skyrocketed in recent years. Preventing more cases of HIV/AIDS and HCV will require dealing with the social determinants of health. Needle exchange programs (NEPs) are based on a harm reduction approach that seeks to minimize the risk of infection and damage to the user and community. This article presents an exploratory small-scale quantitative study of the injection drug using habits of a group of injection drug users (IDUs) at a needle exchange program in Fresno, California. Respondents reported significant decreases in high risk IDU behaviors, including sharing of needles and to a lesser extent re-using of needles. They also reported frequent use of clean paraphernalia. Greater collaboration between social and health outreach professionals at NEPs could provide important frontline assistance to people excluded from mainstream office-based services and enhance efforts to reduce HIV/AIDS or HCV infection.

COMPARING THE AUTOMATIC THOUGHTS AND FEELINGS OF INFERIORITY AMONG INTRAVENOUS DRUG USERS WHO ARE LEAVING WITH METHADONE, HIV +, SUFFERING FROM HEPATITIS C AND CONTROL

Background and Objective: According to the hepatitis and AIDS both are chronic and important disease in the last century it was decided to investigate the feelings of inferiority and automatic thoughts in three groups of injecting drug users who are leaving with methadone that a group was developed to HIV-positive and the other with hepatitis c and control group that included intravenous drug users treated for leaving with methadone that was the Negative HIV and was not developed to hepatitis C. Methodology: In this cross-sectional analytical study, automatic thoughts and feeling of inferiority were investigated in three groups of injecting drug users who were leaving with methadone. The first group with hepatitis C, second group infected to HIV and the third group (control group) who were free of these diseases. 120 intravenous drug users were mentioned who were leaving with methadone that 40 people infected with HIV, 40 people with hepatitis C and 40 were lack of both diseases and referred to the clinics for leaving drug and behavioral counseling of Yazd, were selected and studied in purposive sampling method. Results: The mean score of inferiority feeling in patients HIV+ and in patients with hepatitis c was 2.25 ± 5.33 2.59 ± 4.55 and in control group has obtained 2.32 ± 3.63. Average difference of Inferiority feeling score in the group 3 was investigated by variance test and was obtained significant relationship (p-value =0.008) The average of automatic thoughts in patients of HIV + was obtained 2.17 ± 4.78, in patients with hepatitis c 1.9 ± 5.1 and in the control group was obtained 2 ± 4.8. The average difference of automatic thoughts was investigated in group 3 by variance test and was obtained no significant relationship (p-value=0.764). Conclusion: In this study the average of feeling of inferiority among intravenous drug users are leaving with methadone that were HIV + was higher than the control group that showed the importance of psychology and psychotherapy counseling and, if necessary, drug therapy in reducing the feeling of inferiority in the treatment of injecting drug users are leaving with methadone

HCV antiviral therapy in injection drug users: difficult to treat or easy to cure?

Background and rationale of the study. Hepatitis C infection is very common among injection drug users(IDUs). In clinical practice there is reluctance to treat IDUs, because considered difficult-to-treat. Aim of this study was to evaluate the response to antiviral treatment in IDUs compared to non-IDUs.Main results. In this observational retrospective study, 204 non cirrhotic patients(112 IDUs, 92 non-IDUs) with chronic hepatitis C, treated with PEG-IFN and ribavirin in a tertiary centre for IDUs of Southern Italy from 2008 to 2011 were analyzed. Age, sex, genotype, steatosis, response to previous therapy, rapid(RVR), early(EVR), end-of-treatment(ETR), sustained(SVR) virological response were evaluated. IDUs were mainly young and males, with prevalence of genotype 3. A higher SVR rate in IDUs group compared to non-IDUs only in PerProtocol(PP) analysis (90% vs. 78,9% ;p = 0.04). On the contrary, in IntentionToTreat(ITT) analysis, no significant difference was relieved. A higher SVR rate at ITT analyses in naïve non-IDUs patients was found (76,13% vs. 90%, p = 0.021), but at PP analysis wasn’t confirmed. Treatment was well tolerated; a higher dropout rate was reported in IDUs (24 patients) compared to non-IDUs (2 patients). In order to exclude the effect of viral genotypes on SVR a genotype matched statistical analysis was done and no difference was found.Conclusions. IDUs naïve patients, due to young age and high prevalence of genotype 3, appear good candidates to dual antiviral therapy with high SVR rates. Dropout is the main non-response cause among these subjects, but through an optimal monitoring program with a multidisciplinary setting, their “difficult to treat” characteristics can be overcome.

Hepatitis C genotypes distribution in intravenous drug users in tehran.

Dear Editor, I read with interest the published article by Ranjbar Kermani et al. (1). Genotyping of hepatitis C virus (HCV) is important, which provides information about strain variation and characteristics of virus during the treatment and the therapy response rate (2). In addition, it is of epidemiologic value because it sheds light on whether prevalent HCV strains are similar to that endemic ones in a certain region, such as those in the Middle East countries (3, 4). The study by Ranjbar Kermani et al. (1) in low sample size but the result in injecting drug users (IDUs) was interesting. This study indicates that the dominant HCV genotypes among patients were 3a and 1a (1). Most of studies in Iran showed that the dominant genotype was1, which is more common than the other genotypes (2, 4, 5). It may be related to their study on IDUs group. Zahedi et al. reported similar data with dominancy of genotype 3 in patients with a history of heroin abuse (6). Hosseini-Moghaddam et al. reported the genotype 3a as a more common genotype in patients underwent hemodialysis in Tehran (7). In comparison with studies made in Yemen, Kuwait, Iraq, and Saudi Arabia, the most common genotype was type 4 (8). However, subtype 1b in Turkey or the western border of Iran and subtype 3a in Pakistan or eastern border of Iran are more prevalent (3). Genotyping was performed using type-specific primers (1) and they did not report any case with mixed genotype. It was related to the limitation of their method, in the other studies from Tehran, mixed HCV genotypes were also found in 2.5% of cases (2). Ranjbar Kermani et al. did not report any data about the relationship between age and distribution of HCV genotypes (1). Jahanbakhsh Sefidi et al. reported that subtype 1a was the most frequent genotype in patients over 40 years of age and subtype 3a was the most frequent ones in patients younger than 40 years old (2). It seems that distribution pattern of HCV genotypes has changed during recent years and today the infection with genotype 3a is increasing among IDUs and general population with HCV infection (9).

Seroprevalence of Hepatitis E Virus Among Injection Drug Users and Non-Injection Drug Users in Hamadan, West of Iran

Background: Hepatitis E virus (HEV) infection is a self-limited hepatitis and the most common cause of acute adult hepatitis in Asia. Young adults and middle-aged populations are more likely to be infected than other age groups. Objectives: The aim of this study was to determine the seroprevalence of anti-HEV among injection drug users (IDUs) compared to nonIDUs. Patients and Methods: This was a cross-sectional study performed on 131 IDUs referred to Farshchian Hospital, Hamadan, Iran and 131 nonIDUs selected from healthy visitors between March 2011 and March 2012. Anti-HEV IgG was measured in serum by ELISA method (DiaPro, Milan, Italy). Data including age, gender, education, location and duration of injection drug used were collected using a questionnaire. Results: In this study, the seroprevalence of hepatitis E virus antibody among IDUs group was 6.1%, and 1.5% among non-IDU group (Odds Ratio = 5.48; CI = 1/069-22/84), indicating that injection drug users were almost five and a half times more than non-IDUs at risk of HEV infection (P = 0.053). There was no significant association between seroprevalence of hepatitis E virus and education level (P = 0.46), duration of injection (P = 0.38) and location (P = 0.19). Conclusions: Seroprevalence of hepatitis E virus among IDUs group was higher than non-IDU group, which might be due to possible blood transmission of HEV among IDUs.

Variation in CD4 cell count among IDUs versus sexually-infected HIV-positive naïve patients in Romania

Since 2011 Romania is experiencing a dramatic increase of newly diagnosed HIV infections among injecting drug users (IDUs), mainly linked to the introduction of new psychoactive substances (NPS) on the Romanian market, their use being related to higher levels of risk behavior compared to opioid abuse. There is no sufficient data showing the natural course of HIV in subjects infected through IDU – the majority are ART-naive due to recently acquired infection (many are asymptomatic and have a CD4 cell count over 350 cells/cmm) and poor adherence. Our objective was to determine if IDUs have a faster decline in CD4 cells than sexually-infected patients. We performed a retrospective study, including ART-naive HIV-positive patients diagnosed between January 2011 and June 2013 at the National Institute for Infectious Diseases “Prof. Dr. Matei Bals”, who had 2 subsequent CD4 cell count determinations over a timespan of 6-24 months and a baseline CD4 count higher than 350 cells/cmm. Among 1,248 newly diagnosed patients, 234 met these inclusion criteria. The data were statistically analyzed using SPSS version 17 (independent sample t-test, Mann-Whitney test, linear regression; the significance level was set at 0.05). The majority (80%, 187/234) were men and the median age was 29 years (15-76). More than half of the patients (138; 59%) were former or active IDUs, with low socioeconomic status, most of them injecting both opioids and NPS and 55 (40%) of them were in detention at the moment of HIV diagnosis. Among them, 98% were coinfected with HCV, as opposed to only 21% of the sexually-infected patients. Subtype analysis was performed for 64 patients and revealed the following subtypes and circulating recombinant forms (CRF): 50 F1, 3 B, 10 CRF14_BG and 1 CRF14_F. There was no significant difference of CD4 cell count between the two groups at baseline (p=0.55). The median variation of CD4 cells in IDUs was 150 and 42 in the non IDUs group. IDUs had a statistically significant CD4 cell decline (p=0.01). HCV coinfection was also correlated with a faster decline in CD4 cells (p <0.001). The more rapid decline of CD4 cells among IDUs could be explained by direct effect of drugs, differences in the virulence of the HIV strains circulating among IDUs and HCV coinfection. These data highlight the importance of carefully monitoring IDUs with HIV infection and of initiating ART earlier in this risk group.

Echocardiographic Findings Suggestive of Infective Endocarditis in Asymptomatic Danish Injection Drug Users Attending Urban Injection Facilities

Injection drug users (IDUs) account for a considerable number of the hospitalizations for infective endocarditis (IE), but the prevalence of diagnosed and unrecognized IE in IDUs is unknown. The aim of the present study was to assess the prevalence of valvular abnormalities suggestive of IE in IDUs attending a supervised injection facility. We performed transthoracic echocardiographic examinations on-site in the injection facilities. A total of 206 IDUs (mean age 43 ± 9 years, 23% women) with a median injection drug abuse of 18 years (interquartile range 10 to 26) were included. Fourteen IDUs (14 of 206, 7%, 95% confidence interval [CI] 4% to 11%) had a previous history of IE. IDUs with a history of IE were significantly older than IDUs without a history of IE (48 ± 8 vs 42 ± 9years, respectively, p= 0.03) and had a longer duration of injection drug use (27 [18 to 36] vs 17years [10 to 25], p= 0.008). In the subgroup of IDUs with a history of IE, 4 subjects (4 of 14, 29%, 95% CI 11% to 55%) had persistent or relapse vegetations. Of the remaining 10 IDUs with a history of IE, 5 (5 of 10, 50%, 95% CI 24% to 76%) had moderate-to-severe regurgitation. In the subgroup of IDUs without a history of IE, vegetations were seen in 9 subjects (9 of 192, 5%, 95% CI 2% to 9%). This group of IDUs with possibly unrecognized IE was older than IDUs without vegetations (48 ± 12 vs 42 ± 9, respectively, p= 0.04). Among the IDUs without a history of IE who did not have vegetations, 30 IDUs (30 of 183, 16%, 95% CI 11% to 22%) had moderate-to-severe regurgitation with or without concomitant thickening of leaflets. Thus, in IDUs without a history of IE, some extent of valvular abnormalities was seen in 20% (39 of 192, 95% CI 15% to 27%) of subjects. None of the IDUs with valvular vegetations had current symptoms consistent with active IE. In conclusion, valvular abnormalities assessed by echocardiography were prevalent in asymptomatic IDUs without a medical history of IE, and vegetations were seen in 5% of subjects.

Changing patterns of first injection across key periods of the French Harm Reduction Policy: PrimInject, a cross sectional analysis

BackgroundMonitoring of emerging modes of drug consumption in France has identified new patterns of injection among youths with diverse social backgrounds, which may explain the persistence of high rates of hepatitis C virus infection. The circumstances surrounding the first injection have been poorly documented in the group of heavy drug users and in the context of the French opioid substitution treatment (OST) policy that provides expanded access to high-dosage buprenorphine (BHD) MethodsAn Internet survey (Priminject) was conducted from October 2010 to March 2011 with French drug users. Four time periods were compared based on critical dates throughout the implementation of the Harm Reduction Policy in France. ResultsCompared with drug users who injected for the first time prior to 1995, the aspects of drug use for users who recently injected for the first time were as follows: (1) experimentation with miscellaneous drugs before the first injection; (2) an older age at the time of first injection; (3) heroin as the drug of choice for an individual's first injection, notwithstanding the increased usage of stimulant drugs; (4) BHD did not appear to be a pathway to injection; and (5) an increased number of users who injected their first time alone, without the help or presence of another individual. ConclusionThe PrimInject study showed that there is a group of injection drug users that is larger than the group of injection drug users observed in previous studies; therefore, it is necessary to diversify programs to reach the entire spectrum of high-risk users.

Sustained Hyperresponsiveness of Dendritic Cells Is Associated with Spontaneous Resolution of Acute Hepatitis C

Some studies have reported that dendritic cells (DCs) may be dysfunctional in a subset of patients with chronic hepatitis C virus (HCV) infection. However, the function of DCs during acute HCV infection and their role in determining infectious outcome remain elusive. Here, we examined the phenotype and function of myeloid DCs (mDCs) and plasmacytoid DCs (pDCs) during acute HCV infection. Three groups of injection drug users (IDUs) at high risk of HCV infection were studied: an uninfected group, a group with acute HCV infection with spontaneous resolution, and a group with acute infection with chronic evolution. We examined the frequency, maturation status, and cytokine production capacity of DCs in response to the Toll-like receptor 4 (TLR4) and TLR7/8 ligands lipopolysaccharide (LPS) and single-stranded RNA (ssRNA), respectively. Several observations could distinguish HCV-negative IDUs and acute HCV resolvers from patients with acute infection with chronic evolution. First, we observed a decrease in the frequency of mature CD86(+), programmed death-1 receptor ligand-positive (PDL1(+)), and PDL2(+) pDCs. This phenotype was associated with the increased sensitivity of pDCs from resolvers and HCV-negative IDUs versus the group with acute infection with chronic evolution to ssRNA stimulation in vitro. Second, LPS-stimulated mDCs from resolvers and HCV-negative IDUs produced higher levels of cytokines than mDCs from the group with acute infection with chronic evolution. Third, mDCs from all patients with acute HCV infection, irrespective of their outcomes, produced higher levels of cytokines during the early acute phase in response to ssRNA than mDCs from healthy controls. However, this hyperresponsiveness was sustained only in spontaneous resolvers. Altogether, our results suggest that the immature pDC phenotype and sustained pDC and mDC hyperresponsiveness are associated with spontaneous resolution of acute HCV infection.

Cross-reactive neutralizing activity in HIV-1 infected injecting drug users

Background Vaccine elicited HIV-1 specific cross-reactive neutralizing humoral immunity may provide protection against acquisition of HIV-1. Several studies have focussed on a better understanding of cross-reactive neutralizing activity (CrNA) in natural infection, but only in homosexual and heterosexual HIV-1 transmission cases. Methods To analyze the prevalence and characteristics of CrNA in HIV-1 infected individuals who reported injecting drug use as the only risk factor, we screened serum samples from 50 male and 35 female participants of the Amsterdam Cohort Studies (ACS) on injecting drug users (IDU) for CrNA across a heterologous 6-viral panel. For comparison, similar data from the ACS on men who have sex with men (MSM) were available. Results HIV-1 infected IDU showed significantly lower geometric mean IC50 values and a lower proportion of individuals that was capable of neutralizing the majority of viruses in the panel as compared to MSM. This difference was however no longer observed when women were excluded from the IDU group. Interestingly, three out of 50 in the male IDU population qualified as elite neutralizer as compared to 1 out of 299 among MSM. Multivariate analysis with viral load at setpoint, CD4+ count at setpoint, gender and transmission route as co-variates revealed only CD4+ count at setpoint as independently associated with CrNA in serum. Conclusion CrNA prevalence and potency in HIV-1 infected IDU was lower than in MSM. This could be attributed to the presence of women in the cohort, rather than the route of exposure, which could be explained by the fact that women had a higher CD4+ T cell count at setpoint, which was the only independent predictor for the presence of CrNA. Our data may implicate that the ability of an HIV-1 vaccine to elicit CrNA may be lower in women and testing for gender dependent future vaccine efficacy may be recommended.

HCV RNA levels in a multiethnic cohort of injection drug users: Human genetic, viral and demographic associations

In patients with chronic hepatitis C, the hepatitis C virus (HCV) RNA level is an important predictor of treatment response. To explore the relationship of HCV RNA with viral and demographic factors, as well as IL28B genotype, we examined viral levels in an ethnically diverse group of injection drug users (IDUs). Between 1998 and 2000, the Urban Health Study (UHS) recruited IDUs from street settings in San Francisco Bay area neighborhoods. Participants who were positive by HCV enzyme immunoassay were tested for HCV viremia by a branched-chain DNA assay. HCV genotype was determined by sequencing the HCV nonstructural 5B protein region. For a subset of participants, IL28B rs12979860 genotype was determined by Taqman. Among 1,701 participants with HCV viremia, median age was 46 years and median duration of injection drug use was 26 years; 56.0% were African American and 34.0% were of European ancestry (non-Hispanic). Human immunodeficiency virus type 1 (HIV-1) prevalence was 13.9%. The overall median HCV RNA level was 6.45 log(10) copies/mL. In unadjusted analyses, higher levels were found with older age, male gender, African-American ancestry, hepatitis B virus infection, HIV-1 infection, and IL28B rs12979860-CC genotype; compared to participants infected with HCV genotype 1, HCV RNA was lower in participants with genotypes 3 or 4. In an adjusted analysis, age, gender, racial ancestry, HIV-1 infection, HCV genotype, and IL28B rs12979860 genotype were all independently associated with HCV RNA. The level of HCV viremia is influenced by a large number of demographic, viral, and human genetic factors.

Injection Drug Users’ Perspectives on Placing HIV Prevention and Other Clinical Services in Pharmacy Settings

In their role as a source of sterile syringes, pharmacies are ideally situated to provide additional services to injection drug users (IDUs). Expanding pharmacy services to IDUs may address the low utilization rates of healthcare services among this population. This qualitative study of active IDUs in San Francisco explored perspectives on proposed health services and interventions offered in pharmacy settings, as well as facilitators and barriers to service delivery. Eleven active IDUs participated in one-on-one semistructured interviews at a community field site and at a local syringe exchange site between February and May 2010. Results revealed that most had reservations about expanding services to pharmacy settings, with reasons ranging from concerns about anonymity to feeling that San Francisco already offers the proposed services in other venues. Of the proposed health services, this group of IDUs prioritized syringe access and disposal, clinical testing and vaccinations, and provision of methadone. Pharmacists' and pharmacy staff's attitudes were identified as a major barrier to IDUs' comfort with accessing services. The findings suggest that although IDUs would like to see some additional services offered within pharmacy settings, this is contingent upon pharmacists and their staff receiving professional development trainings that cultivate sensitivity towards the needs and experiences of IDUs.

“Injection First”: A Unique Group of Injection Drug Users in Tijuana, Mexico

Using baseline data from a study of injection drug users (IDUs) in Tijuana, Mexico (N = 1,052), we identified social and behavioral factors associated with injecting at the same age or earlier than other administration routes of illicit drug use (eg, "injection first") and examined whether this IDU subgroup had riskier drug using and sexual behaviors than other IDUs. Twelve-percent "injected first." Characteristics independently associated with a higher odds of "injection first" included being younger at first injection, injecting heroin as their first drug, being alone at the first injection episode, and having a sexual debut at the same age or earlier as when they initiated drug use; family members' illicit drug use was associated with lower odds of injecting first. When adjusting for age at first injection and number of years injecting, "injection first" IDUs had lower odds of ever overdosing, and ever trading sex. On the other hand, they were less likely to have ever been enrolled in drug treatment, and more commonly obtained their syringes from potentially unsafe sources. In conclusion, a sizable proportion of IDUs in Tijuana injected as their first drug using experience, although evidence that this was a riskier subgroup of IDUs was inconclusive.

Hepatitis C treatment and injecting drug users in Perth, Western Australia: Knowledge of personal status and eligibility criteria for treatment

Background: Few injecting drug users (IDU) in Australia take part in antiviral therapy for chronic hepatitis C (HCV). To assess whether IDU are aware of the eligibility criteria for treatment and their personal HCV status, we surveyed 78 IDU attending the fixed-site needle exchange in the city of Perth.Method: Participants were eligible for the study if they self-reported having ever been diagnosed as HCV antibody positive. Each participant completed a semi-structured questionnaire administered by a peer HCV educator at the needle exchange.Results: Knowledge of personal HCV status was poor with more than half of the group not knowing the purpose of a polymerase chain reaction test. Knowledge of treatment eligibility was also poor especially around issues relating to alcohol consumption, the need for a liver biopsy, and treatment during pregnancy.Conclusion: Up-to-date information about eligibility criteria for HCV treatment has not filtered down to this group of older IDU. Furthermore, knowledge of personal HCV status (chronic infection and infectivity) needs to be improved. Informed decisions about treatment cannot be made if knowledge of status is poor and IDU are not familiar with treatment eligibility.

An external evaluation of a peer-run outreach-based syringe exchange in Vancouver, Canada

Objective Vancouver, Canada has been the site of an epidemic of human immunodeficiency virus (HIV) amongst injection drug users (IDU). In response, the Vancouver Area Network of Drug Users (VANDU) initiated a peer-run outreach-based syringe exchange programme (SEP) called the Alley Patrol. We conducted an external evaluation of this programme, using data obtained from the Vancouver Injection Drug Users Study (VIDUS). Methods Using generalised estimating equations (GEE) we examined the prevalence and correlates of use of the SEP amongst VIDUS participants followed from 1 December 2000 to 30 November 2003. Results Of 854 IDU, 233 (27.3%) participants reported use of the SEP during the study period. In multivariate GEE analyses, service use was positively associated with living in unstable housing (adjusted odds ratio [AOR] = 1.83, 95% confidence interval [CI]: 1.39–2.40), daily heroin injection (AOR = 1.31, 95% CI: 1.01–1.70), daily cocaine injection (AOR = 1.34, 95% CI: 1.03–1.73), injecting in public (AOR = 3.07, 95% CI: 2.32–4.06), and negatively associated with needle reuse (AOR = 0.65, 95% CI: 0.46–0.92). Conclusion The VANDU Alley Patrol SEP succeeded in reaching a group of IDU at heightened risk for adverse health outcomes. Importantly, access to this service was associated with lower levels of needle reuse. This form of peer-based SEP may extend the reach of HIV prevention programmes by contacting IDU traditionally underserved by conventional syringe exchange programmes.

Longitudinal trajectories of ketamine use among young injection drug users

Background Ketamine is a dissociative anaesthetic that became increasingly popular in the club and rave scene in the 1980s and 1990s. Reports surfaced in the late 1990s indicating that ketamine was being injected in several U.S. cities by young injection drug users (IDUs). Since all studies on ketamine injection were cross-sectional, a longitudinal study was undertaken in 2005 to determine: characteristics of young IDUs who continue to inject ketamine; frequency of ketamine injection over an extended time period; risks associated with ongoing ketamine injection; and environmental factors that impact patterns of ketamine use. Methods Young IDUs aged 16–29 with a history of injecting ketamine ( n = 101) were recruited from public locations in Los Angeles and followed during a 2-year longitudinal study. A semi-structured instrument captured quantitative and qualitative data on patterns of ketamine injection and other drug use. A statistical model sorted IDUs who completed three or more interviews ( n = 66) into three groups based upon patterns of ketamine injection at baseline and follow-up. Qualitative analysis focused on detailed case studies within each group. Results IDUs recruited at baseline were typically in their early 20s, male, heterosexual, white, and homeless. Longitudinal injection trajectories included: “Moderates,” who injected ketamine several times per year ( n = 5); “Occasionals,” who injected ketamine approximately once per year ( n = 21); and “Abstainers,” who did not inject any ketamine during follow-up ( n = 40). Findings suggest that ketamine is infrequently injected compared to other drugs such as heroin, cocaine, and methamphetamine. Most IDUs who begin injecting ketamine will stop or curb use due to: negative or ambivalent experiences associated with ketamine; an inability to find the drug due to declining supply; or maturing out of injecting drugs more generally. Conclusion Reducing ketamine injection among young IDUs may best be accomplished by targeting particular groups of IDUs identified in this study, such as homeless youth and homeless travellers.

The risk of HIV and HCV infections among injection drug users in northeast India

Injection drug users (IDUs) and their associated risk behavior are responsible for driving the human immunodeficiency virus (HIV) epidemic in northeast India. So a group of IDUs from two northeastern states (Mizoram and Nagaland) of India were studied to find the prevalence of HIV, co-infection with hepatitis C virus (HCV), hepatitis B virus (HBV), and associated risk behaviors. Out of the 400 IDUs enrolled, 398 consented for HIV, HCV, and hepatitis B surface antigen (HbsAg) test. Of them, 10.8% were HIV-1 antibody positive, 47.8% had HCV antibody, and 3.8% had detectable HBsAg. Among the HIV infected subjects, 79.1% were co-infected with HCV and 6.9% had triple infection. Heroin users showed a higher association with HIV (OR = 7.3, 95% CI: 2.5–21.5, p=0.0003) and HCV infection (OR = 7.6, 95% CI: 3.5–16.6, p<0.0001) than Spasmo-proxyvon (dextropropoxyphene, a synthetic opiod analgesic). In summary, apart from the known risk variables among IDUs, type of injecting drugs also influences the HIV/HCV transmission pattern among the IDUs.