History Of Intravenous Drug Use Research Articles

CLINICAL AND LABORATORY PROFILE OF PATIENTS WITH HEPATITIS B INFECTION ATTENDING THE OUTPATIENT DEPARTMENT OF A TERTIARY CARE HOSPITAL IN NORTHEAST INDIA

Objective: The objective of this study was to analyze the clinical and laboratory profile of patients with hepatitis B infection-attending outpatient departments of tertiary care hospitals in northeast India. Methods: This was a cross-sectional study conducted in the outpatient department of a tertiary care medical institute situated in northeast India. Eighty patients infected with hepatitis B (on the basis of serological markers) were included in this study on the basis of predefined inclusion and exclusion criteria. Demographic details such as age, gender, and socioeconomic status of all the patients were noted. A detailed history was taken including any history of intravenous drug use, tattooing, sexual contacts, history of blood transfusions, and familial liver disease. Clinical and laboratory profiles (liver function test and serological markers) of all the patients were studied. Ultrasound imaging was done in all the cases. p<0.05 was taken as statistically significant. Results: Out of 80 studied cases, there were 49 (61.25%) males and 31 (38.75%) females. The mean age for males and females was 32.30±8.03 and 34.70±13.52 years, respectively. There was no significant difference in mean age between males and females (p=0.3218). Mother-to-child transmission was evenly distributed with 7 males (8.75%) and 9 females (11.25%) affected. Other risk factors, such as dental implants and surgeries, showed a lower prevalence, with dental implants impacting 2 males (2.5%) and 3 females (3.75%) and surgeries concerning 5 males (6.25%) and 3 females (3.75%). Majority of the patients (52.5%) were asymptomatic and were found to be hepatitis B surface antigen (HBsAg) positive incidentally. HBsAg was positive in all cases. 12 (15%) patients showed the presence of hepatitis B e antigen suggestive of high infectivity. Anti-HBc and anti-HBe were positive in 68 (85%) patients each. Hepatomegaly was seen in 23 cases (28.75%) on ultrasound. Moderate fibrosis on elastography was seen in 2 (2.5%) cases. Conclusion: In cases of hepatitis B, the majority of the patients remained asymptomatic, and many cases no risk factor for hepatitis B virus infection could be identified. It is therefore important to screen the general population for hepatitis B infection.

Analysis of Transesophageal Echocardiography Appropriateness for Diagnosing Infective Endocarditis: Insights from Two Tertiary Care Hospitals

BackgroundEchocardiography plays a key role in the diagnosis of infective endocarditis (IE), with published recommendations regarding the appropriate use of transesophageal echocardiogram (TEE). The objective of this study is to evaluate the utilization of TEE in Regina, Saskatchewan, in the diagnosis of IE. MethodsA retrospective chart review was performed on patients aged ≥ 18 years who received a TEE for the diagnosis of IE from January 1 to December 31, 2019. Primary outcome included the proportion of TEEs that complied with ACCF/ASE and ESC recommendations. ResultsThere were 204 admissions involving 188 patients who had a TEE performed for the diagnosis of IE within the study period. The mean age was 53.1 ± 17.1 years. Of the 204 TEEs, 152 (74.5%) were considered appropriate by the ACCF/ASE recommendations. Patients who had at least one predisposing condition (aOR 4.30 (95% CI 2.11-9.04), p < 0.001)) were more likely to be associated with appropriate TEE use by ACCF/ASE criteria. Of the 204 TEEs, only 80 (39.2%) were considered appropriate by the ESC recommendations. Patients who had a history of intravenous drug use (aOR 3.08 (95% CI 1.08-9.27), p = 0.04)) and blood cultures positive for IE-related organisms (aOR 2.31 (95% CI 1.16-4.80), p = 0.02)) were more likely associated with appropriate TEE use by ESC recommendations. ConclusionsThe current study suggested that the use of TEE in the diagnosis of IE demonstrated variable adherence to published recommendations by ACCF/ASE and ESC, with significant discrepancy between the two.

Percutaneous Disc Biopsy versus Bone Biopsy for the Identification of Infectious Agents in Osteomyelitis/Discitis

PurposeTo determine whether sampling of the disc or bone is more likely to yield positive tissue culture results in patients with vertebral discitis and osteomyelitis (VDO). Materials and MethodsRetrospective review was performed of consecutive patients who underwent vertebral disc or vertebral body biopsy at a single institution between February 2019 and May 2023. Inclusion criteria were age ≥18 years, presumed VDO on spinal magnetic resonance (MR) imaging, absence of paraspinal abscess, and technically successful percutaneous biopsy with fluoroscopic guidance. The primary outcome was a positive biopsy culture result, and secondary outcomes included complications such as nerve injury and segmental artery injury. ResultsSixty-six patients met the inclusion criteria; 36 patients (55%) underwent disc biopsy, and 30 patients (45%) underwent bone biopsy. Six patients required a repeat biopsy for an initially negative culture result. No significant demographic, laboratory, antibiotic administration, or pain medication use differences were observed between the 2 groups. Patients who underwent bone biopsy were more likely to have a history of intravenous drug use (26.7%) compared with patients who underwent disc biopsy (5.5%; P = .017). Positive tissue culture results were observed in 41% of patients who underwent disc biopsy and 15% of patients who underwent bone biopsy (P = .016). No vessel or nerve injuries were detected after procedure in either group. ConclusionsPercutaneous disc biopsy is more likely to yield a positive tissue culture result than vertebral body biopsy in patients with VDO.

Standardized order set for the management of infective endocarditis.

Infective endocarditis (IE) is a potentially life-threatening infection that affects the inner lining of the heart, particularly the heart valves. Patients with preexisting heart conditions, damaged heart valves, or a history of intravenous drug use are at a higher risk of acquiring IE. A rural acute care facility reported that 68.75% of patients who had a methicillin-resistant Staphylococcus aureus infection were diagnosed with IE. Review of medical records showed that 65% of patients with IE did not have antibiotic start/stop dates and 51% were discharged before the 6-week completion date. The quality-improvement project used a pretest and posttest design. An order set was created based on evidence-based guidelines to assist with the management of patients with IE. The order set included administering intravenous (IV) antibiotics for a minimum of 6 weeks for patients with IE and included a set of recommended weekly follow-up laboratory tests. An order set with the standard of care and reminders in the electronic health records (EHRs) were implemented for the management of IE, including antibiotic start and stop dates and weekly follow-up labs. After implementation, there was an improvement in the completion of IV antibiotics, documentation of start/stop dates for IV antibiotics, and completion of recommended laboratory tests. An order set with the standard of care and reminders in the EHR reduced variations in care and improved patient outcomes by ensuring that all providers were following the same evidence-based guidelines for the management of IE.

Septic Arthritis of the Sternoclavicular Joint.

Sternoclavicular joint (SCJ) septic arthritis is a rare but rapidly fatal joint infection. Without proper medical or surgical management, it can progress to osteomyelitis, chest wall abscess, mediastinitis, or myositis. A 57-year-old male with a past history of intravenous drug use presented to the emergency department (ED) with chest tenderness of one week duration. Vital signs were unremarkable, and exam was notable for tender, raised right SCJ without any fluctuance. On point-of-care ultrasound we noted fluid collection and capsular distention along the SCJ, which aided in rapidly diagnosing septic arthritis. The patient was immediately started on antibiotics and taken to the operating room for excision and debridement. While computed tomography is routinely used in the emergency department for diagnosing septic arthritis, ultrasound offers a rapid and safe alternative for diagnosis.

Finding the Balance: The Point-of-Care Ultrasound Diagnosis of Pseudoaneurysm

A 49-year-old male with history of intravenous drug use presented to the Emergency Department with localized right arm swelling that has been slowly growing for months. On physical exam, there was a golf ball sized mass in the right antecubital fossa without overlying skin changes and no neurovascular deficits in the distal extremity. Point-of-care ultrasound (POCUS) was performed utilizing a water bath with visualization of bidirectional swirling in a round cavity adjacent to the brachial artery. Aneurysms are abnormal focal dilations that result from vascular wall defects. Ultrasound has been reported to have 94% sensitivity and 97% specificity for diagnosis of pseudoaneurysms. On color doppler ultrasound, pseudoaneurysm is characterized by the pathognomonic “yin-yang” sign. In the case of the 49-year-old male with a right antecubital mass and history of IVDU, the proposed mechanism of injury was trauma to the arterial wall secondary to auto-injection. POCUS has been found to improve identification of abscesses and its incorporation in patient evaluation can guide clinical management, prevent unwanted iatrogenic exsanguination, and determine whether there is a need for urgent vascular surgery intervention, particularly in high-risk patients.

Infective Endocarditis in an Intravenous Drug User Leading to Myocardial Rupture and Hemopericardium.

Infective endocarditis (IE) is an infectious disorder of the innermost lining of the heart that can be fatal if left untreated. Infective endocarditis can spread beyond the endocardium into the myocardium and cause arrhythmias and myocardial wall rupture. Individuals with a history of intravenous drug use are at increased risk of developing IE and are at higher risk of dying, given their limited access to health care and adherence to treatment. A medicolegal autopsy was performed on a 30-year-old woman with a history of intravenous drug use and recent assault after a hospital admission during which she did not survive resuscitation. The cause of death was found to be myocardial rupture in the setting of transmural IE. Postmortem imaging showed hemopericardium which was identified grossly with valvular vegetations in the heart. A ventricular wall defect along with transmural abscess formation was identified. Perimortem toxicology was positive for fentanyl, methamphetamine, and benzoylecgonine, a metabolite of cocaine. Postmortem blood cultures were positive for coagulase-negative Staphylococci, Staphylococcus aureus, Candida tropicalis, and Viridians group Streptococci. Postmortem tissue cultures taken from the heart was positive for Candida glabrata and Streptococcus mitis. The decedent had significant risk factors for IE, such as intravenous drug use and a prior admission to hospital for IE. The organisms identified on culture are in-keeping with the gross findings of IE and the terminal event of myocardial rupture was likely the result of tissue damage resulting from IE.

Hepatitis C Prevalence on the Rise but Screening at Safety Net Institutions Lagging behind.

In the United States, the hepatitis C virus (HCV) is a leading contributor to liver-related illnesses and fatalities. Despite effective antiviral medications, acute infections have increased in recent years, likely due to IV drug use and the opioid epidemic. Previous guidelines recommended one-time screening for individuals born between 1945 and 1965. The CDC now recommends screening all adults over 18 unless there is a low prevalence in the area. Accurate measurement of HCV prevalence is essential for targeted prevention. In New York, over 100,000 individuals have HCV. We present data on HCV screening at a safety net hospital in Long Island, NY. To identify screening rates for hepatitis C and the exposure prevalence and specific demographics of a community in Long Island, NY. We performed a review of all patients seen in our hospital from 2012 to 2019. We identified patients born in the years 1945 to 1965 using our electronic medical record (EMR) system and subsequently analyzed those who were anti-HCV positive. We reviewed their demographics, including age, gender, and ethnicity, as well as their history of intravenous drug use and HIV coinfection status. Basic statistical analysis was used. Our study identified 21,722 patients born between 1945 and 1965 and found that only 8.5% or 1,858 individuals were screened for hepatitis C. Among them, we found that 5.9% (109) tested positive for HCV antibody, with 3.0% (56) having an active infection. Demographic characteristics of those with HCV antibodies included 70.6% male, 53.2% Caucasian, 33.9% Black, and 15.6% persons who inject drugs (PWID). Our study findings suggest that a significant portion of patients in our community had missed opportunities for screening in our hospital. Our community had an estimated 5.9% prevalence, higher than the national and state averages. Caucasian men had higher prevalences. This study suggests the need for broader screening initiatives and more focused resource allocation, perhaps to safety net institutions, to decrease the burden of HCV.

Effect of combination antibiotic therapy on clinical failure rate for skin and soft tissue infections

BackgroundDespite guideline recommendations for skin and soft tissue infection (SSTI) consisting of empirical single antibiotic therapy, multiple studies have evaluated the use of a first-generation cephalosporin and sulfamethoxazole-trimethoprim or clindamycin to optimize coverage for staphylococcal and streptococcal species. No studies have evaluated a tetracycline with a cephalosporin for this indication. ObjectiveThis study evaluated combination therapy with doxycycline plus cephalexin compared with cephalexin or doxycycline alone in SSTI. MethodsThis retrospective, single-center cohort study, conducted at an academic medical center, included consecutive adults who visited the emergency department (ED) with an SSTI, identified with ICD-10 codes, and received a prescription for cephalexin, doxycycline, or both. Admitted patients or those with antibiotics in the previous 30 days or wound care for chronic infections were excluded. The primary outcome was clinical failure defined as documented worsening of infection or incision and drainage (I&D) on follow-up, change in antibiotic, or subsequent hospitalization. Chi-square test was used for the primary outcome. ResultsPatients (N = 419) were predominately white, Hispanic, males with a mean age of 46 ± 16 years, and consistent between groups. History of intravenous drug use was present in 23% of patients, most often in the doxycycline (30%) or combination groups (30%). Clinical failure occurred in 49 patients (12%). There was no difference in clinical failure between cephalexin and combination therapy (17 vs. 13, P = 0.45) or doxycycline versus combination therapy (19 vs. 13, P = 0.27). The predominant reason for clinical failure was worsening of infection (31), followed by change in antibiotic (18) and hospitalization (16). I&D predominately occurred in the doxycycline (44%) and combination groups (30%), with methicillin-resistant Staphylococcus aureus being the most commonly identified organism (15). ConclusionIn ED patients with SSTI, single antibiotic therapy did not result in increased incidence of clinical failure compared with combination therapy with a first-generation cephalosporin and tetracycline.

Difficult Intravenous Access Requiring Ultrasound in the Emergency Department: Associations With Delays in Care and Areas for Quality Improvement.

Background Patients with difficult intravenous access (DIVA) requiring ultrasound-guided intravenous (USGIV) access have been associated with delays in treatment, imaging, and disposition in academic emergency department (ED) patient populations. Our objective in this study was to characterize differences in time to intravenous access, imaging, and disposition between patients with DIVA versus those without DIVA requiring USGIV access in a community ED while also assessing for DIVA-associated comorbidities. Methods A cross-sectional, observational analysis was performed on admitted ED patients evaluated from September 2to September 31, 2022, at a community ED. Patients with DIVA were defined as patients with two failed attempts at traditional intravenous placement. These patients require USGIV placement per institutional protocol. Patients younger than 18 years of age, trauma admissions, repeated visits from the same patient, patients with missing data, and direct hospital admissions were excluded. Continuous variables were recorded with medians and included ED throughput measures of time to vascular access, contrast CT imaging, and disposition. Differences in median times between DIVA patients versus non-DIVA patients were assessed with the Mann-Whitney U-test. Categorical data involving comorbidities were reported as percentages, and differences in proportions between DIVA versus non-DIVA patients were assessed via chi-square tests. Multivariate logistic regression analysis evaluated for correlations between DIVA and times to access, contrast CT imaging, disposition, and significant covariates while adjusting for demographic information. Results A total of 1250 patients were included in this investigation (5.8% associated with DIVA requiring USGIV access). The median age of all subjects was 69 (interquartile range = 58, 79) with no significant difference between the DIVA and non-DIVA groups. Patients with DIVA were more likely to be female in comparison to patients without DIVA (65.3% and 51.2%, respectively, p < 0.05). Patients with a history of end-stage renal disease (ESRD) (p < 0.001), intravenous drug use (IVDU) (p < 0.001), and venous thromboembolism (p < 0.05) had statistically significant associations with DIVA. On regression analysis, patients with DIVA were more likely to have a history of ESRD with an odds ratio (OR) of 3.56 (95% confidence interval (CI): 1.62-7.81) and a history of IVDU with an OR of 14.29 (95% CI: 5.17-39.54). Patients with DIVA were associated with statistically significant greater median times to vascular access, contrast CT imaging, and disposition (p < 0.001 for time to access and disposition and p < 0.01 for time to contrast CT imaging). Conclusion In this study, DIVA cases requiring USGIV access were positively associated with significantly longer times to access, contrast CT imaging, and disposition compared to patients without DIVA at our community ED. Comorbidities such as IVDU and ESRD had statistically significant associations with DIVA requiring USGIV access.

A Mysterious Presentation of Small Bowel Stricture

Small bowel adenocarcinoma is a rare malignancy that accounts for a small percentage of gastrointestinal cancers. Diagnosis and management of small bowel adenocarcinoma can be challenging due to its rarity and nonspecific presentation. We present a case of a 51-year-old male with a history of intravenous drug use who presented with worsening abdominal pain and was found to have a small bowel obstruction. Exploratory laparotomy revealed a stricture in the jejunum caused by an intraluminal mass, which was resected. Pathological examination confirmed the diagnosis of intestinal type, moderately differentiated adenocarcinoma. This case highlights the importance of considering small bowel adenocarcinoma as a possible etiology in patients presenting with small bowel obstruction, particularly in high-risk individuals. Early diagnosis and complete resection remain the mainstays of treatment for improved outcomes in small bowel adenocarcinoma.

Situation of HDV Infection in Adult Hepatitis B Patients at The Outpatient Clinic of Pasteur Institute in Ho Chi Minh City

Hepatitis D virus (HDV) infection, also known as delta virus, has been identified as a crucial risk factor contributing to severe complications among hepatitis B patients. Such complications arise as HDV accelerates the progression towards cirrhosis, exacerbates the risk of decompensated cirrhosis, and increases mortality rates compared to non-HDV hepatitis B infections. Despite its clinical significance, data on HDV infection remains scarce, and exhibits marked regional disparities in Viet Nam. This study endeavors to explore HDV co-infection in adult hepatitis B patients. A descriptive cross-sectional investigation was conducted, involving 539 hepatitis B subjects attending the Outpatient Clinic of the Pasteur Institute in Ho Chi Minh City between October 2021 and May 5, 2022. The study sample featured three hepatocellular carcinoma (HCC) patients, 148 patients with elevated alanine aminotransferase (ALT) levels, and nine patients whose ALT levels exceeded five times the upper limit of normal (ULN). Additionally, 11 patients reported a history of blood transfusion, while no participants had any history of intravenous drug use. Remarkably, the study did not document any instances of HDV co-infection among the subjects. These findings suggest that HDV screening may not be a routine recommendation for patients diagnosed with moderate or mild hepatitis B, particularly when presenting with low-risk factors. Further research is warranted to better understand the prevalence of HDV co-infection in this population and to guide the development of evidence-based screening guidelines.

Intravenous Drug Use‐Associated Endocarditis Leads to Increased Intracranial Hemorrhage and Neurological Comorbidities

Background The United States is experiencing a rapidly increasing rate of opioid drug abuse. Intravenous drug use (IVDU)‐related endocarditis can lead to significant neurological complications with high morbidity and mortality. When patient care necessitates anticoagulation, the standards for radiographic screening and the risk for intracranial hemorrhage are not clearly elucidated. Methods We conducted a retrospective cohort study involving patients treated for infective endocarditis at a single institution from 2014 to 2018. Patients were grouped based in history of IVDU and their demographics and clinical predictors for intracranial hemorrhage were analyzed. Results A total of 351 patients met inclusion criteria for this study, of whom 170 patients (48%) had a history of IVDU‐associated endocarditis. IVDU was associated with an increased prevalence of intracranial hemorrhage (25.9% versus 13.9%; P =0.005), including intraparenchymal hemorrhage (12.4% versus 5.1%; P =0.012), subarachnoid hemorrhage (17.6 versus 4.4%; P =0.001), and cerebral microbleeds (14.1% versus 7.2%; P =0.022). IVDU was also associated with an increased incidence of infectious intracranial aneurysm (10.6% versus 1.8%; P =0.001) and brain abscesses (4.7% versus 1.1%; P =0.025). Multivariate analysis showed that the presence of intracranial septic emboli (odds ratio [OR], 18.47 [8.4–40.250]; P =0.001) and infectious intracranial aneurysm (OR, 12.38 [3.24–47.28]; P =0.001) as significant predictive factors for intracranial hemorrhage after presenting with endocarditis. Conclusion The opioid epidemic has increased the incidence of infective endocarditis and resultant neurovascular complications. IVDU‐associated endocarditis is associated with increased hemorrhagic stroke and more frequent neurodiagnostic imaging.

Arare Serratia marcescens-associated acute endocarditis of atricuspid valve in an intravenous drug user : Acase report and literature review.

Serratia marcescens is agram-negative bacillus that is an opportunistic agent in respiratory tract infections, urinary tract infections, and septicemia. It is rarely also acause of infective endocarditis which follows arapid and devastating course, typically in persons with history of intravenous drug use (IDU). This article reports afatal case of a27-year-old patient with aknown history of IDU, who presented with clinical symptoms concerning right-sided endocarditis as well as signs of acute respiratory distress syndrome. Finally, adetailed review of the literature is provided concerning the acute endocarditis of atricuspid valve, especially associated with Serratia marcescens infection.

Paenibacillus thiaminolyticus sepsis and meningoencephalitis in a 37-day old preterm infant

Introduction: The Paenibacillus genus consists of saprophytic organisms that are commonly associated with soil, water, plants, feces, and diseased insect larvae. Human infection is rare. This disease typically occurs in immunocompromised hosts, adults with a history of intravenous drug use, and hosts with prosthetic medical devices. There are a limited number of case reports describing Paenibacillus infections in neonates. This is the second published instance of pediatric meningoencephalitis caused by Paenibacillus thiaminolyticus in a preterm infant with intrauterine drug exposure. Case Report: A 37-day-old male infant with a history of prematurity of 33 weeks completed gestation presented to the Emergency Department for acute onset poor feeding, poor color, and unresponsiveness at home. Examination revealed cyanosis, apnea, and hypotonia. Vital signs were significant for hypotension and hypothermia. Initial labs revealed a metabolic acidosis, elevated C-reactive protein, normal complete white blood cell count, and a negative viral respiratory pathogen panel. Aerobic blood culture and cerebrospinal fluid (CSF) culture were positive for P. thiaminolyticus within 24 hours. Cranial ultrasound and magnetic resonance imaging revealed changes concerning for liquefactive meningoencephalitis. The infant was admitted to the neonatal intensive care unit (NICU) and ultimately discharged home on a “do not resuscitate/do not intubate” status and later died at 11 months of age. Conclusion: Paenibacillus species are common environmental organisms but can cause devastating disease in neonates. This is the second reported case of a preterm infant with P. thiaminolyticus infection and inutero drug exposure (IUDE), supporting that prematurity and IUDE may be risk factors for severe disease.

Monitoring syphilis serology in blood donors: Is there utility as a surrogate marker of early transfusion transmissible infection behavioral risk?

In Canada the time deferral for gay, bisexual, and other men who have sex with men (gbMSM) was progressively shortened (lifetime, 5 years, 1 year, 3 months). Here we describe trends in syphilis rates (a potential sexual risk marker) and risk behaviors from blood donors in the past 12 years. Syphilis positivity in 10,288,322 whole blood donations (January 1, 2010-September 10, 2022) and gbMSM deferral time periods, donation status, age, and sex were analyzed with logistic regression. Overall, 26.9% syphilis positive and 42.2% controls (matched 1:4) participated in risk factor interviews analyzed by logistic regression. Syphilis rates were higher in first-time donors (OR 27.0, 95% CI 22.1-33.0), in males (OR 2.3, 1.9-2.8) and with the 3-month deferral (OR 3.4, 2.6-4.3) during which the increase was greater for first-time males (p < .001) but similar for male and female repeat donors (p > .05). Among first-time donors, histories of intravenous drug use (OR 11.7, 2.0-69.5), male-to-male sex 7.8 (2.0-30.2) and birth in a high prevalence country (OR 7.6, 4.4-13.0) predicted syphilis positivity; among repeat donors, history of male-to-male sex (OR 33.5, CI 3.5-317.0). All but 1 gbMSM syphilis-positive donors were noncompliant with the gbMSM deferral. About a quarter of first-time interviewed case donors had history of syphilis; 44% were born in a high-prevalence country. Rising syphilis rates in donors correlates with the general population epidemic. Recent infection rates rose similarly in males and females. GbMSM history may contribute to donor syphilis rates but shortening time deferrals appears unrelated.

Candida dubliniensis Meningitis in Immunocompetent Adults - case report and review of literature (P10-10.001)

<h3>Objective:</h3> NA <h3>Background:</h3> NA <h3>Design/Methods:</h3> We report a case and review the cases of <i>Candida dubliniensis</i> meningitis in immunocompetent adults. <h3>Results:</h3> 32 years old man with history of intravenous drug use (IVDU) presented with seizures, nuchal rigidity, and papilledema. Head CT showed communicating hydrocephalus and brain and spine MR showed diffuse leptomeningeal enhancement extending to the cauda equina. HIV, syphilis, and quantiferon-gold tests were negative but his CD4 count was 203 (430 – 1185/mm3). Lumbar puncture showed opening pressure of 45 mm H2O, CSF protein &gt; 392 mg/dl (15–45), glucose 5 mg/dL (40–70), nucleated cells 246 (0–5), 83% lymphocytes, red blood cells 1 (0–1). CSF meningitis panel was negative, but encephalitis panel showed NMDA receptor antibody. 1,3-Beta-D-glucan was 79 (&lt;60 pg/mL) in the serum and 295 in the CSF and CSF cultures grew <i>Candida dublinens</i>is. <h3>Conclusions:</h3> Chronic base of the skull meningitis has many causes including inflammatory conditions, malignancies, and infections. Invasive <i>C. dublinensis</i> infection is very rare and usually associated with immunodeficiency (HIV or post-transplant). This is the fourth case of <i>C. dublinensis</i> in an immunocompetent host described in the literature. Like our case, in two of those three reports the infection was associated with IVDU, and this information is not available for the third case. This corroborates the hypothesis that IVDU could be a risk factor for this infection. Regarding his CSF NMDA receptor antibody, he did not have limbic encephalitis, dysautonomia, seizures or psychiatric symptoms. There is a known association of this antibody and ovarian teratomas and herpes simplex encephalitis but no association with <i>Candida sp.</i> is known. Despite his low CD4 count he did not have other opportunistic infections. No etiology was identified for this finding. <b>Disclosure:</b> Dr. Horta has nothing to disclose. Dr. White has nothing to disclose. Dr. Greige has nothing to disclose. Dr. Askari has nothing to disclose. Dr. Cervantes-Arslanian has nothing to disclose.

Hepatitis C Infection and Treatment among Injecting Drug Users Attending General Practice: A Systematic Review and Meta-Analysis

The care provided in general practice to intravenous drug users (IDUs) with hepatitis C (HCV) extends beyond opioid substitution therapy. An aggregated analysis of HCV service utilization within general practice specifically related to diagnosis and treatment outcomes remains unknown from previous literature. This study aims to estimate the prevalence of HCV and analyze data related to the diagnosis and treatment-related outcomes of HCV patients with a history of intravenous drug use in the general practice setting. A systematic review and meta-analysis in general practice. This review included studies published in the following databases: EMBASE, PubMed, and Cochrane Central Register of Controlled Trials. Two reviewers independently extracted data in standard forms in Covidence. A meta-analysis was done using a DerSimonian and Laird random-effects model with inverse variance weighting. A total of 20,956 patients from 440 general practices participated in the 18 selected studies. A meta-analysis of 15 studies showed a 46% (95% confidence interval (CI), 26-67%) prevalence rate of hepatitis C amongst IDUs. Genotype information was available in four studies and treatment-related outcomes in 11 studies. Overall, treatment uptake was 9%, with a cure rate of 64% (95% CI, 43-83%). However, relevant information, such as specific treatment regimens, treatment duration and doses, and patient comorbidities, was poorly documented in these studies. The prevalence of HCV in IDUs is 46% in general practice. Only ten studies reported HCV-related treatment outcomes; however, the overall uptake rate was below 10%, with a cure rate of 64%. Likewise, the genotypic variants of HCV diagnoses, medication types, and doses were poorly reported, suggesting a need for further research into this aspect of care within this patient group to ensure optimal treatment outcomes.

Abstract 4179: Anal cancer risk factors and utilization of cancer preventive strategies in people living with HIV in Puerto Rico

Abstract Introduction: Anal cancer (AC) risk is greatly elevated among persons living with HIV (PLWH), particularly men who have sex with men (MSM). The incidence of anal cancer among PLWH in Puerto Rico is 60.5 per 100,000 in MSM. Smoking and sexual behaviors may enhance anal cancer risk among PLWH. Therefore, we describe the prevalence of risk factors for AC, overall and by sexual risk group (MSM, women, and men who have sex with women [MSW]). We also evaluated receipt of cancer preventive strategies: HPV vaccination and AC screening, among a sample of PLWH in Puerto Rico. Methods: A cross-sectional study was conducted (Sept 2020 - Dec 2021) among PLWH ≥26 aged in Puerto Rico (n=212). Participants answered a phone interview that collected information on relevant characteristics. AC risk factors evaluated were current smoking, age of sexual initiation (≤15 years), lifetime anal sex, 10 or more lifetime sexual partners, history of AIDS, genital warts, and HPV infection. HPV vaccination and AC screening status were also evaluated. The overall and sexual risk group specific prevalence of AC risk factors and preventive behaviors were described. In addition, the prevalence ratio (PR) of the variables of interest, comparing the sexual risk groups, was estimated with 95% confidence intervals using Poisson regression. Results: Mean age of participants was 52.8 ± (SD=10.2); 44.1% were MSM, 23.2% were MSW, and 32.7% were women. Most PLWH had public health insurance (84.4%), an education level of high-school or less (45.7%), and 9.5% had a history of intravenous drug use. Regarding the prevalence of AC risk factors, 58.3% had 10 or more lifetime sex partners, 51% had their first sexual relationship at age ≤15 years, 29.3% were current smokers, and 75.8% of women had history of anal sex. In addition, 20.8% reported being diagnosed with AIDS, 16.5% had a history of genital warts, and 12.0% had HPV infection. Only 7.5% reported HPV vaccination and 52.2% reported ever having had an anal pap test. MSM had the highest prevalence of risky sexual behaviors, although no statistical difference was seen in the PRs. For preventive strategies, women (PR: 3.13, 95% CI 1.52-6.46) and MSM (PR: 3.42, 95% CI 1.70-6.90) had higher prevalence of anal pap uptake than MSW. Conclusion: Persons living with HIV in Puerto Rico had high prevalence of current smoking use and risky sexual behavior. Despite their increased risk of AC, and only over half had been screened for AC. Continued education and awareness about AC risk factors, smoking cessation, and importance of prevention strategies are important among PLWH. Citation Format: Sandra I. Garcia-Camacho, Jeslie M. Ramos-Cartagena, Marievelisse Soto-Salgado, Vivian Colon-Lopez, Karen J. Ortiz-Ortiz, Ashish A. Deshmukh, Ana P. Ortiz. Anal cancer risk factors and utilization of cancer preventive strategies in people living with HIV in Puerto Rico. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4179.

Causes of HIV Treatment Interruption during the Last 20 Years: A Multi-Cohort Real-Life Study

In the last years, many antiretroviral drugs (ART) have been developed with increased efficacy. Nowadays, the main reasons for treatment switches are adverse events, proactive strategy or simplification. We conducted a retrospective cohort study to investigate the reason for treatment interruption in the last 20 years. We merged data of eight cohorts of the SCOLTA project: lopinavir/r (LPV), atazanavir/r (ATV), darunavir/r or /c (DRV), rilpivirine (RPV), raltegravir (RAL), elvitegravir/c (EVG), dolutegravir (DTG) and bictegravir (BIC). We included 4405 people with HIV (PWH). Overall, 664 (15.1%), 489 (11.1%), and 271 (6.2%) PWH interrupted the treatment in the first, second, and third years after starting a new ART. Looking at the interruption in the first year, the most frequent causes were adverse events (3.8%), loss to follow-up (3.7%), patients' decisions (2.6%), treatment failure (1.7%), and simplification (1.3%). In the multivariate analysis regarding experienced patients, treatment with LPV, ATV, RPV or EVG/c, having less than 250 CD4 cells/mL, history of intravenous drug use, and HCV positivity were associated with an increased risk of interruption. In naive people, only LPV/r was associated with an increased risk of interruption, while RPV was associated with a lower risk. In conclusion, our data on more than 4400 PWH show that adverse events have represented the most frequent cause of treatment interruptions in the first year of ART (3.84%). Treatment discontinuations were more frequent during the first year of follow-up and decreased thereafter. First-generation PI in both naïve and experienced PWH, and EVG/c, in experienced PWH, were associated with a higher risk of treatment interruptions.