Infections In Intravenous Drug Users Research Articles

A simple, once-daily dosing regimen for treating HIV-1 infection in intravenous drug users.

A simple, once-daily dosing regimen for treating HIV-1 infection in intravenous drug users.

Prevalence, patterns, and course of past hepatitis B virus infection in intravenous drug users with HIV-1 infection

OBJECTIVE: Hepatitis B virus (HBV) and human immunodeficiency virus (HIV) share common routes of transmission. Therefore, markers of either active or past HBV infection are present in many HIV-infected patients, particularly in intravenous drug users (IDUs). The aim of this study was to analyze the serological pattern of past HBV infection (presence or absence of anti-HBs) and the course of past HBV infection (changes in anti-HBs status, and HBV reactivation) in two cohorts of IDUs with and without HIV infection. METHODS: HBV serum markers were studied in 388 HIV-positive and 197 HIV-negative IDUs. Among them, 263 HIV-positive and 50 HIV-negative patients with past HBV infection (serum HBsAg negative and anti-HBc positive, with or without anti-HBs) were followed-up for a median of 21 and 13 months, respectively, to detect changes in anti-HBs status and HBV reactivation. RESULTS: The prevalence of HBV infection (either active or past) was higher in HIV-positive than in HIV-negative cases (90% vs 62%, p < 0.001), even when stratified by years of drug use. Most cases (92% of HIV-positive and 89% of HIV-negative) had markers of past infection. Among those patients with past HBV infection, 60% of HIV-positive and 72% of HIV-negative presented serum anti-HBs ( p = 0.03). The incidence of anti-HBs loss was 1.8 cases/100 person-year in HIV-positive, and 1.8 cases/100 person-year in HIV-negative patients (RR 1.0, 95% CI 0.1–94, p = NS). Incidence of anti-HBs development was 17.6 cases/100 person-year in HIV-positive and 25.6 cases/100 person-year in HIV-negative IDUs (RR, 1.5, 95% CI, 0.6–3.5, p = NS). Only one HIV-positive patient with markers of past HBV infection developed an active infection (0.2 events/100 person-year). CONCLUSIONS: HBV infection (either active or past) is particularly frequent in HIV-positive IDUs. Most cases have markers of past infection. Isolated detection of anti-HBc (absence of anti-HBs) is more common in HIV-positive than in HIV-negative IDUs. Despite their progressive immunosuppression, both anti-HBs loss and HBV reactivation are rare in HIV-infected IDUs.

Prevalence, patterns, and course of past hepatitis B virus infection in intravenous drug users with HIV-1 infection.

Hepatitis B virus (HBV) and human immunodeficiency virus (HIV) share common routes of transmission. Therefore, markers of either active or past HBV infection are present in many HIV-infected patients, particularly in intravenous drug users (IDUs). The aim of this study was to analyze the serological pattern of past HBV infection (presence or absence of anti-HBs) and the course of past HBV infection (changes in anti-HBs status, and HBV reactivation) in two cohorts of IDUs with and without HIV infection. HBV serum markers were studied in 388 HIV-positive and 197 HIV-negative IDUs. Among them, 263 HIV-positive and 50 HIV-negative patients with past HBV infection (serum HBsAg negative and anti-HBc positive, with or without anti-HBs) were followed-up for a median of 21 and 13 months, respectively, to detect changes in anti-HBs status and HBV reactivation. The prevalence of HBV infection (either active or past) was higher in HIV-positive than in HIV-negative cases (90% vs 62%, p < 0.001), even when stratified by years of drug use. Most cases (92% of HIV-positive and 89% of HIV-negative) had markers of past infection. Among those patients with past HBV infection, 60% of HIV-positive and 72% of HIV-negative presented serum anti-HBs (p = 0.03). The incidence of anti-HBs loss was 1.8 cases/100 person-year in HIV-positive, and 1.8 cases/100 person-year in HIV-negative patients (RR 1.0, 95% CI 0.1-94, p = NS). Incidence of anti-HBs development was 17.6 cases/100 person-year in HIV-positive and 25.6 cases/100 person-year in HIV-negative IDUs (RR, 1.5, 95% CI, 0.6-3.5, p = NS). Only one HIV-positive patient with markers of past HBV infection developed an active infection (0.2 events/100 person-year). HBV infection (either active or past) is particularly frequent in HIV-positive IDUs. Most cases have markers of past infection. Isolated detection of anti-HBc (absence of anti-HBs) is more common in HIV-positive than in HIV-negative IDUs. Despite their progressive immunosuppression, both anti-HBs loss and HBV reactivation are rare in HIV-infected IDUs.

Clostridial Infections in Intravenous Drug Users

Outbreaks of systemic infection with clostridial species have previously been noted among intravenous drug users (IDU), but morbidity and mortality are generally limited. An outbreak of unexplained illness and death among IDU, identified in the U.K. in April and continuing into June 2000, appears to be associated with clostridial disease. Hospitalization, death, or …

Infrequent detection of TT virus infection in intravenous drug users, prostitutes, and homosexual men: Macdonald DM, Scott GR, Clutterbuck D, Simmonds P, et al. J Infect Dis 179:686–689

Infrequent detection of TT virus infection in intravenous drug users, prostitutes, and homosexual men: Macdonald DM, Scott GR, Clutterbuck D, Simmonds P, et al. J Infect Dis 179:686–689

DETECTION OF HTLV-IIB AND HTLV-IIC AMONG SOUTH BRAZILIAN BLOOD DONORS, INTRAVENOUS DRUG USERS AND PATIENTS WITH NEUROLOGICAL DISEASE.

P175 Background: HTLV-II is endemic in a number on indigenous Indian groups of the Americas and high rates of infection have been documented in intravenous drug users (IVDUs) in North and South America, Europe and Southeast Asia. Previous studies have shown that infection in IVDUs in South Eastern Brazil and in Amazonian Indian populations involves a unique molecular subtype of the virus, HTLV-IIC. In Porto Alegre, in the South of Brazil, the seroprevalence of HTLV-I/II infection ranges from 0.4 to 1.2%, of which 17% have been typed as HTLV-II. Objective: To identify the molecular subtypes of HTLV-II present in the HTLV-II infected population of Porto Alegre. Methods: In a cohort study based in the city of Porto Alegre, established between 1994 and 1998, we identified 59 individuals with HTLV-II infection by Western Blot (HTLV Blot 2.4, Genelabs, Singapore) and/or PCR. The majority were blood donors, but this population also included infected family members, individuals of Amerindian descent, intravenous drug users and several patients with neurological disorders. PBMC DNAs were obtained from 18 individuals and analysed by PCR amplification, RFLP and nucleotide sequence analysis. Results: PCR amplification was successful in 16 samples. RFLP analysis demonstrated that 11 were infected with HTLV-IIC and 5 with HTLV-IIB. The HTLV-IIC population consisted of 5 females and six males, median age 35.6 years. This included 6 Caucasians, 4 Afroamericans and 1 Amerindian descendant. Six of these individuals were members of two families; 5 were blood donors, 2 had neurologic disorders and 1 was an IVDU, coinfected with HIV-1. The HTLV-IIB population consisted of 4 females and one male, median age 48,4 years. This included 2 Caucasians, 2 Afroamericans and 1 individual of Amerindian descent. Four were blood donors and 1 was an IVDU, also coinfected with HIV-1. Conclusions: The city of Porto Alegre, in the South of Brazil, appears to be an endemic area for HTLV-I and HTLV-II infection. The present study has demonstrated that HTLV-II infection involves both the HTLV-IIB and HTLV-IIC subtypes and occurs in individuals both with and without risk factors for infection. As far as we are aware this is the first report of HTLV-IIB infection and Brazil and the study supports the association of HTLV-II infection with the development of neurological disease.

Infrequent detection of TT virus infection in intravenous drug users, prostitutes, and homosexual men.

TT virus (TTV), a recently discovered DNA virus, has been implicated as a cause of non-A to non-C posttransfusion hepatitis. The frequency of TTV in persons considered at high risk for sexual and parenteral infection was investigated (52 prostitutes, 81 homosexual men, 65 intravenous drug users) to assess its mode of transmission. TTV DNA was assayed by polymerase chain reaction using primers from conserved regions in the N22 clone. Viremia frequency was 4.5%-13.0% in study subjects, not significantly different from that in low-risk controls (2 [4.5%] of 44). The frequency of TTV viremia increased significantly with age (P=.018) but was not associated with human immunodeficiency virus coinfection. The low frequency of infection detected in both risk groups suggests that spread by sexual contact or by intravenous drug use is relatively inefficient and unlikely to account for the high prevalence of TTV observed worldwide.

Retrospective analysis of the impact of HIV infection and alcohol use on chronic hepatitis C in a large cohort of drug users

Background/Aim: This retrospective study aimed to better define the respective biological and pathological impact of human immunodeficiency virus infection and chronic alcohol consumption on the course of hepatitis C virus infection in intravenous drug users. Methods: Two hundred and ten consecutive anti-HCV positive intravenous drugs users, among whom 60 were also anti-HIV positive, took part in the study at the University Hospital, Paris, France. Results: The activity of aspartate aminotransferase and gamma-glutamyl transpeptidase was significantly increased in serum from anti-HIV positive patients. The mean hepatitis activity index was significantly higher in anti-HIV positive patients ( p<0.05), among whom there was also a higher proportion of patients with cirrhosis as compared to anti-HIV negative patients (30.0 vs 15.3%, p<0.0001). Excessive alcohol drinking (recorded in around 35% of the patients, whatever their HIV status), as compared to non-excessive drinking, was more often associated with cirrhosis in anti-HIV negative (24.5 vs 11.3%, p<0.05) than in anti-HIV positive patients (30.4 vs 29.7%, not significantly). In a multivariate analysis, HIV infection (relative risk 2.2, confidence interval 1.1–4.5) and excessive alcohol drinking (relative risk 1.9, confidence interval 1.0–3.9) were the variables independently associated with the risk of cirrhosis. Conclusion: Human immunodeficiency virus infection worsens the course of chronic hepatitis C in intravenous drug users. Excessive alcohol drinking also appears to be a crucial negative cofactor, and therefore alcohol withdrawal should be proposed as an integral part of the therapy.

An HTLV-I/II Vaccine: From Animal Models to Clinical Trials?

A human T-lymphotropic virus type I/II (HTLV-I/II) vaccine is necessary in view of two etiologically related, life-threatening diseases, namely, adult T-cell leukemia/lymphoma and tropical spastic paraparesis/HTLV-I-associated myelopathy. When the risk of developing autoimmune diseases such as uveitis, polymyositis, and arthritis is included, one can estimate the life-long risk of infected individuals to develop an HTLV associated pathology as approximately 10%. The populations at risk are, in a large majority, from developing countries but the epidemic of HTLV-II infection in intravenous drug users (IVDU) represents a possible reservoir for dissemination in the general population. The number of HTLV-I-infected individuals (15 to 25 million), together with the severity of associated disease, justifies the development of a vaccine. Different vaccine preparations have been developed, using mostly recombinant pox and adenoviruses, but DNA plasmid technology will soon become a feasible approach. Various animal models exist for experimental viral infections, involving rats, rabbits, or monkeys, but up to now, neither hematological nor neurological disorders have been induced by HTLV infection in such animal models. For long-term protection from HTLV-I-associated diseases, vaccination should induce both neutralizing antibodies and specific cell-mediated immunity. This will require the incorporation of both env and gag coding sequences in the vaccine preparations. Preventive clinical trials may involve different cohorts of seronegative young girls from endemic areas prior to sexual activity and IVDU in the industrialized world. In parallel, one should consider therapeutic vaccine trials in HTLV-I-positive mothers and IVDU to protect them against disease development. The observed rate of seroconversion in these different cohorts makes such trials feasible.

Bacteriology of Skin and Soft-Tissue Infections: Comparison of Infections in Intravenous Drug Users and Individuals with No History of Intravenous Drug Use

The bacteriology of cutaneous or subcutaneous abscesses (86 specimens) among intravenous drug users (IVDUs) was compared with the bacteriology of abscesses (74 specimens) in patients with no history of intravenous drug use (non-IVDUs). The IVDU abscesses yielded 173 aerobes and 131 anaerobes. Staphylococcus aureus was the most common aerobe isolated (50% of specimens yielded this isolate), followed by "Streptococcus milleri" (46%). The commonly encountered anaerobes were Fusobacterium nucleatum (17%), pigmented Prevotella species (22%), Peptostreptococcus micros (17%), Actinomyces odontolyticus (15%), and Veillonella species (13%). The non-IVDU isolates included 116 aerobes and 106 anaerobes. S. aureus was isolated from 53% of these specimens, followed by coagulase-negative staphylococci (19%), "S. milleri" (19%), and Streptococcus pyogenes (16%). The main groups of anaerobes were Peptostreptococcus species (35%), Bacteroides species (19%), and gram-positive bacilli (31%). Overall, 67% of the IVDU isolates were of oral origin, compared with 25% of the non-IVDU isolates. Of the specimens from IVDUs and non-IVDUs, 48% and 67%, respectively, yielded only aerobes, and 2% and 4%, respectively, yielded only anaerobes. Sixty-four percent of the patients had one or more beta-lactamase-producing organisms.

Molecular epidemiology of hepatitis C virus infection among intravenous drug users

Background/Aims: The clinico-pathologic features of hepatitis C virus infection intravenous drug users are different from those found in other hepatitis C virus-infected patients. Our airm was to test whether specific viral variants circulate within this particular patient population. Methods: We studied the distribution of hepatitis C virus genotypes in 90 drug addicts and 484 controls, according to the method described by Okamoto. Results: Hepatitis C virus type 1a and 3a infections were more frequent among intravenous drug users than in 125 age-matched controls (48.8% and 21.1% vs 17.6% and 11.2%), accounting for the majority of infections in intravenous drug users. Analysis of hepatitis C virus genotypes according to age showed that, in the general population, hepatitis C virus types 1a and 3a were more prevalent among patients younger than 40 years of age than in older individual (17.6% and 11.2% vs. 1.4% and 0.6%). Conclusions: These findings suggest that hepatitis C virus types 1a and 3a were recently introduced in Italy, presumably via needle-sharing among intravenous drug users, and from this reservoir they are extending to the general population, particularly among younger subjects.

Trends in Incidence and Prevalence of HIV-1 Infection in Intravenous Drug Users in Valencia, Spain

Our objective was to describe and compare the trends of incidence and prevalence of HIV-1 infection in intravenous drug users (IDUs) in Valencia, Spain in 1987-1992. A cohort study was carried out in AIDS Information Centers located in the Valencia Region (Spain). Point seroprevalence was calculated for in each year according to HIV status at the first contact. Incidence annual rates were calculated from those IDUs identified as seronegative in their first visit and who returned for a new testing. From a total of 4,207 IDUs who contacted these centers, 4,131 (98.2%) asked voluntarily for HIV-1 testing. The seroprevalence for the whole period was 48.4% (95% C.I., 46.88, 49.92). Follow-up information was available for 604 subjects of the total 2,130 subjects who were seronegative in their first visit. The incidence rate for the 1988-1992 period was 12.02/100 person-years (95% C.I., 9.62, 14.41). Prevalence showed an overall decreasing pattern with a minimum corresponding to the year 1992 (43.6%). Incidence rates increased mildly until 1990 (13.93 per 100 person-years), to stabilize beyond at approximately 10 per 100 person-years. Our incidence rates are very high regardless of the decline of prevalence. Effective risk reduction programs among IDUs have been almost nonexistent in Spain up to now and should become an immediate priority.

Imprisonment: a risk factor for HIV infection counteracting education and prevention programmes for intravenous drug users

To examine changes of risk behaviour and its determinants as well as risk factors for HIV infection in intravenous drug users (IVDU) with particular attention to imprisonment and its risk patterns.In 1993 a multisite cross-sectional study was carried out by standardized questionnaires and blood/saliva samples in which 612 IVDU from Berlin were enrolled.Multifactorial analysis revealed that the most important risk factor for HIV infection was needle-sharing in prison. In total, 353 IVDU (58%) reported reduced risk behaviour; changes related more to injection behaviour than sexual practices (91 versus 68%). Important determinants for needle-sharing during the last 6 months were intravenous drug use in prison, duration of drug-taking history, and knowledge of a negative HIV test. The most frequently reported reasons for current needle-sharing were having shared needles with only one regular partner (45%) and imprisonment (26%).Information campaigns and other prevention measures appear to have produced risk awareness in IVDU, and as a consequence, a reduction in risk behaviour. The situation in prisons (no sterile injecting equipment, no effective disinfectants), however, is counteractive to prevention measures implemented outside prisons. An important task for future strategies should be to enable IVDU to avoid HIV transmission while in prisons.

Modeling Incidence Rate Ratio and Rate Difference: Additivity or Multiplicativity of Human Immunodeficiency Virus Parenteral and Sexual Transmission among Intravenous Drug Users

The analysis concerns data from the Northern Italian Seronegative Drug Addicts Study, a multicenter longitudinal study about the incidence of human immunodeficiency virus infection in intravenous drug users from Milan and other areas of northern Italy between 1987 and 1991. Different measures of parenteral and heterosexual exposure effects were estimated by fitting multiplicative models for rate ratio and additive models for both rate ratio and rate difference into a Poisson regression model for grouped cohort data. In areas of high human immunodeficiency virus prevalence among intravenous drug users, the adjusted rate ratio under a multiplicative structure was 6.2 (95% likelihood-based confidence interval (LCI) 2.9-14.4) for parenteral and 2.9 (95% LCI 1.3-6.1) for sexual transmission. Under the additive model, the rate ratio was 7.8 (95% LCI 3.4-20.2) for parenteral and 9.2 (95% LCI 2.2-29.7) for sexual transmission, and the rate difference per 100 person-years was 9.8 (95% LCI 5.3-15.6) for parenteral and 10.5 (95% LCI 1.8-24.2) for sexual transmission (controlled for each other). Because of the small sample size, a clear discrimination between models could not be reached. However, in spite of the greater risk associated with parenteral transmission under a multiplicative model, the additive model suggests that the relative impact of measures aimed at inducing condom use is similar to that which would be obtained by measures aimed at stopping syringe sharing.

Prevalence and Epidemiologic Correlates of Human T Cell Lymphotropic Virus Infection Among Intravenous Drug Users

Intravenous drug users (IVDUs) in Seattle (n = 213) were studied to identify the prevalence and predominant types of and risk factors for human T cell lymphotropic virus (HTLV) infection. Detailed questionnaires, serologic screening, and polymerase chain reaction analysis (for a subset) were used. Evidence of HTLV infection was found in 16.5%, of which 89% were HTLV-II. HTLV infection was significantly associated with nonwhite race, older age, more years of intravenous drug use, prior use of heroin, history of gonorrhea, history of any sexually transmitted disease, hepatitis B virus infection, and antibody to herpes simplex virus type 2 (HSV-2). By stepwise logistic regression analysis, associations persisted with race, age, hepatitis B markers, and HSV-2. Thus, the strong association of HTLV with hepatitis B, a marker for injection behavior, and the independent association with HSV-2 infection, a sexually transmitted pathogen, suggest similarities in the epidemiology of HTLV and human immunodeficiency virus infections in IVDUs.

HIV surveillance by testing saliva from injecting drug users: a national study in New Zealand.

To determine whether the prevalence of HIV infection among injecting drug users in New Zealand has remained low since the introduction of a needle and syringe exchange scheme in May 1988. Anonymous survey of intravenous drug users attending outlets of the exchange scheme, based on questionnaires and saliva testing. Twelve pharmacies and community outreach organisation in six cities. Altogether 620 people provided saliva specimens and completed questionnaires. These represented 73% of those who visited exchange scheme outlets during a three month period in 1992. Saliva was tested for antibodies to HIV-1 and HIV-2 using an IgG-capture enzyme linked immunosorbent assay (GACELISA). Of 591 specimens eligible for inclusion, only three (0.5%) were repeatedly reactive in the GACELISA test, while two of these were also positive in a Western blot test. Although surveys show that sharing of needles and syringes was common in New Zealand until recently, the prevalence of HIV infection in intravenous drug users has remained low. This can probably be attributed to the success of educational campaigns and legislative action to allow a needle and syringe exchange scheme to be set up.

Use of a Dublin inner city A & E department by patients with known HIV-1 infection.

During the period January 1990 to January 1992 260 patients known to be infected with human immunodeficiency virus type 1 (HIV-1) attended the Accident & Emergency (A & E) Department of St James's Hospital, Dublin. There was a total of 709 visits with a mean annual attendance rate of 2.7, twice that for the general A & E population. Eighty-nine per cent of patients were intravenous drug users (IVDUs), 9% homosexual/bisexual and 2% heterosexual. Known HIV-1 seropositive patients accounted for 0.7% and 0.8% of the total number of patients who attended A & E in 1990 and 1991 respectively. The majority of patients disclosed their HIV status. Bacterial respiratory tract infection was the single most common reason for attending A & E and for admission to hospital. Seventy-two per cent of IVDUs fulfilled Centers of Disease Control (CDC) criteria for stage II and III disease; the majority of these used A & E for primary medical care, although listed with a general practitioner (GP) and attending during the daytime. Sixty-eight per cent of homosexuals/bisexuals were CDC stage IV with AIDS defining illnesses accounting for 52.6% of clinical presentations. Of this risk category, 79% required medical admission. Homosexuals/bisexuals represent more advanced disease, thus the full impact of HIV-1 infection in IVDUs in this A & E setting has yet to be realized.

L'infection VIH chez les toxicomanes intraveineux

Clinical course of HIV infection was studied among 156 intravenous drug users (IVDU). Mean follow up was 22.7 months. Characteristics of HIV infection in IVDU were frequent oral candidiasis and bacterial infections (BI), more frequent progression to AIDS after a second BI, rapid decline of CD4+ in a group of current IVDU. Progression to AIDS was 14.5% per year, not different among current and former IVDU. Twenty five IVDU died.

Determinants of HIV-1 infection in intravenous drug users in Valencia, Spain, 1987-1991.

From 1987 through 1991, 2687 intravenous drug users recruited at three AIDS information centres in the Region of Valencia (Spain) were interviewed about drug use and sexual behaviour and subsequently tested for HIV-1 antibody. The overall seroprevalence was high, 50% (95% confidence interval [CI]: 41.8-51.9%). There were no differences by gender, but HIV-1 infection was related to older age and city of residence. After adjustment by means of logistic regression age (odds ratio [OR] = 1.80), sharing of injection equipment (OR = 2.16), duration of addiction (OR = 6.59) and prostitution (OR = 1.77) were significantly associated with HIV-1 prevalence. High educational level was inversely related to HIV-1 status (OR = 0.43) and a decreasing trend of prevalence with time was observed.

T-Lymphocyte Subsets in Intravenous Drug Users With HIV-1 Infection

<h3>To the Editor.</h3> —Recently, Margolick et al¹reported on changes in CD4 and CD8 T-lymphocyte subsets in intravenous drug users (IVDUs). In their words, "The principal finding was the slow rate of decline in CD4 lymphocyte counts in HIV-1 [human immunodeficiency virus type 1] seropositive IVDUs over a 2.5-year period of observation." (Actual observation period was 18 months.) The authors assert that this finding contradicts "the common perception that HIV-1 infection in IVDUs leads to rapid decline in CD4 lymphocytes." Howev Follow-up, Acquired Immunodeficiency Syndrome (AIDS) Incidence, and Rates of Change in CD4⁺Lymphocyte Numbers in the San Giovanni Hospital Subcohort of the MPH Study, by CD4⁺Lymphocyte Level at Baseline* Baseline CD4 Level, Cells/μL Developed AIDS No. (%) Incidence† Median Follow-up, Semesters 1.16 Changes/6 mo Median Mean &lt;150 4(44) 34.36 -42.92 10.90 150-299 20 4(20) 2.08 2.42 6.25 23.80 26 6(23) 6.37 -15.31 450-599 45 6(13) 3.19 3.66 -29.79