Infections In Injection Drug Users Research Articles

Bacterial infections in people who inject psychoactive substances: An observational study in a French university hospital

To describe bacterial infections in injection drug users (IDUs) hospitalized at Montpellier University Hospital, France, and to identify factors that might influence the development of local or systemic infections. This cross-sectional observational monocentric study prospectively included bacterial infections in IDUs hospitalized at Montpellier University Hospital between 2012 and 2018. Types of infection (local or systemic) were described and compared to identify specific features (injection practices). The study included 144 bacterial infections (56% of local infections and 44% of systemic infections) concerning 117 IDUs. The most common infection types were abscesses (50%), skin and soft tissue infections (33%), bacteremia/sepsis (20%), endocarditis (17%), and bone and joint infections (16%). Patients were mainly men (n=94; 80%), and the median age was 40 years [IQR25-75: 34-47]. Four deaths related to systemic infection were reported. The most frequent injected substances were cocaine, opioid maintenance treatments (OMT), and opioids. According to the multivariate analysis, factors associated with the occurrence of systemic infections were number of injection (OR 2.59 [1.07-6.27]; P=0.034) and injection of at least one opioid (OR 3.52 [1.28-9.72]; P=0.015). Different types of bacterial infections, local or systemic, are observed in IDUs. Skin infections are quite common, but other infection types also are reported, with sometimes serious consequences. It is already known that injection practices are contributing factors in infection development, but the type of injected psychoactive substance(s) also may have an influence.

Streptococcus intermedius is the most common streptococcus in soft tissue infections in injection drug users

Background: There have been reports of “Streptococcus milleri” group (now Streptococcus anginosus group) SAG, in soft tissue infections in iv drug users (IVDU). However, the significance of Streptococcus intermedius (SI) has not been reported. In our study of 1321 streptococcal isolates SI was the predominant Streptococcus in IVDU soft tissue infections. Other 2 members of the group, S constellatus (SC) and S anginosus (SA) were less frequent. Methods and materials: We studied 1321 Streptococcal isolates from different body sites admitted to our 10 network hospitals during a 3 year period ending in December 2019.There were 125 (9.5%) group A, 481 (36.4%) group B, 78 (5.9%) group C, 83 (6.3%) group G, 335 (25.4%) Streptococcus anginosus group (SAG) and 45 S gallolyticus and 174 others.There were 335 Streptococcus anginosus group (SAG) isolates from 167 males and 166 females, with ages ranging from 1 month to 90 years, consisting of 151 (84 M/67F) S anginosus, 107 (56 M/51F) SI and 77 (47 M/30/F) S constellatus (SC). We reviewed the clinical presentation, lab results, and susceptibilities of all streptococcal isolates. There were 32 drug users in patients culture positive for streptococci. Results: Streptococcal infections in 32 IV drug users were: 15 (46.9%) SI, 9 (28.1%) group A, 4 (12.5%) SA, 3 Streptococcus constellatus (9.4%), 1 each group C, group F, S dysgalactiae and alpha Streptococcus sp. There were no group B or G infections associated with IVDU. Majority were in the upper extremity 24/31 (77.4%), with 4/31 (12.9%) lower extremity, 1 pneumonia and 1 line infection. Other oral bacteria present in mixed infections were Prevotella oralis, P denticola, P intermedius, Eikenella corrodens, Haemophilus para influenzae and group C Streptococcus. Of 7 positive blood cultures in IVDU 5 were group A, one SI and 1 SC. Conclusion: SAG was common in soft tissue infections in IVDU with SI being the predominant Streptococcus. In IVDU with bacteremia, group A Streptococcus was the most common blood isolate. Mixed infections with other oral bacteria were often present. Group B and group G Streptococci were not isolated in IVDU in this study.

Drug use in the spread and forming of epidemic of hiv infection

The paper reviews issues of drug use in the spread of HIV infection through sexual and injection routes, interaction of drug addicts with the general population, the main psychoactive substances used by drug addicts, the practices that contribute to the transmission of HIV from a drug addict to a healthy person, the representation of drug addicts in risk groups, the course of infections among injecting drug users (IDUs), treatment of drug use and infections in IDUs. The role of drug addiction in maintaining the HIV epidemic is shown. It is observed that people involved in seafaring are in high-risk area by drug addiction as well as by spread of HIV infection. Marine regions are among the most affected.

Infections in Injection Drug Users: The Significance of Oral Bacteria and a Comparison with Bacteria Originating from Skin and Environmental Sources

Infections are common in IV drug users (IVDU). Heroin was by far the most common drug abused in our series of 80 patients. The spectrum of infections in our patients with ages ranging from 20-63, varied from mild skin infections to life threatening and fatal conditions such as septic shock, necrotizing fasciitis, spinal cord infarction and endocarditis with cerebral septic emboli. Our studies showed that bacterial infections in IV drug users originate from three different sources: 1. Skin (contaminated hands) 2. Oral microbiota 3. Environmental sources including water, soil and plants. The most common skin bacteria isolated were methicillin susceptible and methicillin resistant Staphylococcus aureus (MSSA and MRSA). In our study Streptococcus anginosus group was the most common oral bacteria in IVDU with Streptococcus intermedius predominating, followed by group A Streptococcus, Prevotella spp., Eikenella corrodens, Haemophilus parainfluenzae and group C Streptococcus. A variety of environmental bacteria were isolated, but the total number of patients in this group was smaller. Bacteria originating from water, soil or plants present were: Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Delftia acidovorans, Commamonas sp., Chryseobacterium spp., Klebsiella spp., Serratia marcesens, Burkholderia cepacia, Pseudomonas fluorescence and Acinetobacter. Twenty four out of 48 (50%) Staphylococcus aureusinfected patients were bacteremic, followed by 6/10 (60%) group A Streptococcus infected cases. Life threatening infections were more common with those infected with Staphylococcus aureus or Pseudomonas aeruginosa. Few had Candida sp., likely of oral origin. Hepatitis C was less common (2/37) 5.4% in the group with oral bacteria and more frequent in MSSA/MRSA patients (13/47) 27.7%. There was 1 coinfection with human immunodeficiency virus each in oral and skin bacteria associated groups. The bacteria isolated provided a clue to the source of infections and habits of the IV drug users.

167. Deep Space Infections in Injection Drug Users (IDU)

BackgroundThe opioid epidemic in the US has increased attention to infectious complications of injection drug use (IDU). The goal of our study was to ascertain the impact of these infections on the health of our community and institutional burden considering that our institution does not discharge patients with IDU for outpatient IV antibiotic treatments due to lack of safe environment and compliance concerns.MethodsThis retrospective study reviewed IDU-associated deep space infections in an 1100 -bed medical center from 2010 through 2014. Pathogens, site of infection, mortality rates and, length of stay (LOS), 3- month readmission (inpatient + observation), leaving against medical advice (AMA) rates for those alive at discharge, were evaluated. ICD-9/10 coding identified admissions related to opioid use and deep infections (endocarditis, diskitis/osteomyelitis, sepsis/bacteremia, empyema). Only the most severe infection was counted for each patient. Charts were reviewed to determine whether IDU was associated with the entree infections.ResultsA total of 505 patients met criteria for deep space infections associated with IDU over 5 years. Of those, 305 (60%) were male, 146 (29%) black, 335 (66%) white, 271 (54%) were on Medicaid, 246 (49%) had sepsis/bacteremia, 67 (13%) had endocarditis,143 (28%) discitis/osteomyelitis, 22 (4%) empyema and 27 (5%) other. Mean age was 46 ± 12 years. LOS varied by disease state. The overall median was 10 days, from 8 days for bacteremia/sepsis up to 27 for endocarditis. There were 43 (9%) hospital deaths; 30 (6%) patients left AMA and 209 (45%) patients were readmitted within 3 months.ConclusionDeep space infections in IDU patients result in long LOS, high mortality and high rates of readmissions and departures AMA. Improved algorithms for management that include psychosocial models and incorporate cost-effective and safe antibiotic administration need to be developed.Disclosures All authors: No reported disclosures.

High rates of cutaneous infections in injection drug users with wounds

High rates of cutaneous infections in injection drug users with wounds

High prevalence of occult hepatitis C virus infection in injection drug users with HIV infection.

One of the pathological forms of chronic hepatitis C is occult HCV infection (OCI), in which there is no detectable HCV RNA in plasma specimens but HCV RNA is present in PBMCs and liver biopsy specimens. The aim of this study is to estimate the prevalence of OCI in HIV-positive people who are injection drug users (IDUs). From April 2015 to August 2018, 161 Iranian IDUs with HIV infection enrolled in the study. Viral RNA was extracted from plasma and PBMC samples of participants, and the presence of HCV RNA was examined using RT nested PCR with primers from two conserved regions (5´-UTR and NS5B). HCV genotyping was performed using RFLP and sequencing methods. Of the 161 patients, 134 (83.2%) were positive for anti-HCV antibodies. All 27 patients who were negative for anti-HCV were also negative for HCV RNA in plasma, but five of them (18.5%) were positive for HCV RNA in PBMCs. Importantly, 9 out of 50 patients (18.0%) who apparently had recovered from HCV infection (i.e., were anti-HCV positive and HCV RNA negative) were positive for HCV RNA in PBMCs. Overall, 18.1% of the patients who had no signs of previous HCV infection or had apparently recovered from the disease had OCI. The HCV genotypes of the cases with OCI were as follows: five patients (35.7%) were infected with subtype 1a, eight patients (57.1%) were infected with subtype 3a, and one patient (7.1%) was infected with genotype 4. Thus, it seems that the prevalence of OCI in HIV-positive IDUs is extremely significant in Iran and is likely to delay the global eradication of HCV infection until 2030.

Infections in Injection Drug Users in New York State

Recognition of local and systemic infection caused by bacterial and fungal organisms in persons who inject drugs (PWID) is longstanding. Now the CDC,

Higher hepatitis C virus‐viral loads and complex sexual partners in hepatitis C virus‐human immunodeficiency virus coinfected injection drug users: A case‐control study

Injection drug users (IDUs) are likely contributors to hepatitis C virus (HCV), hepatitis B virus (HBV), and human immunodeficiency virus (HIV) infections. However, little is known about the HCV viral loads of IDUs with HCV‐HIV coinfection. The aim of this prospective study was to investigate the HCV viral loads among IDUs with HCV infection, HCV‐HIV coinfection, and HCV‐HBV coinfection. Among the 45 IDUs recruited to the study, 27 were HCV monoinfected; 9 were HCV‐HIV coinfected; 7 were HCV‐HBV coinfected; and 2 were seronegative for HCV, HBV, or HIV infection. A control group of 180 age‐ and gender‐matched chronic HCV‐infected patients were enrolled using the propensity score method. A standardized case record form was used to collect demographic, clinical, laboratory, and virological data. The HCV RNA levels in IDUs with HCV‐HIV coinfection were significantly higher than those in the control group, IDUs with HCV monoinfection, and IDUs with HCV‐HBV coinfection (P < 0.001, P < 0.001, and P < 0.001, respectively). The HCV‐RNA levels in the control group were higher than those in IDUs with HCV monoinfection and HCV‐HBV coinfection (P = 0.04 and P = 0.039, respectively). After analyzing the risk factors related to these viral infections in IDUs, a complex sexual partner was more prevalent among IDUs with HCV‐HIV coinfection than those with HCV monoinfection or HCV‐HBV coinfection (P = 0.02 and P = 0.035, respectively). IDUs with HCV‐HIV coinfection demonstrated extremely high HCV‐RNA levels. Antiviral therapy, especially in the directly acting antiviral era, is indicated. In addition, IDUs with a complex sexual partner had a significantly higher risk of HIV infection. Therefore, the measure to curb this transmission is more important for infectious control.

Efficacy and Safety of Tedizolid and Linezolid for the Treatment of Acute Bacterial Skin and Skin Structure Infections in Injection Drug Users: Analysis of Two Clinical Trials.

IntroductionInjection drug users (IDUs) often develop acute bacterial skin and skin structure infections (ABSSSI) and use emergency departments as their primary source for medical care.MethodsA post hoc subgroup analysis of two randomized trials examined the efficacy and safety of tedizolid in the treatment of ABSSSI in IDUs. IDUs (n = 389) were identified from two pooled phase 3 trials (NCT01170221, NCT01421511) in patients with ABSSSI (n = 1333). Patients were randomly assigned to tedizolid phosphate (200 mg once daily, 6 days) or linezolid (600 mg twice daily, 10 days). Primary endpoint was ≥ 20% reduction in lesion area from baseline at 48 –72 h. Secondary endpoints included investigator-assessed clinical and microbiological response at the post-therapy evaluation (PTE).ResultsWound infection was more common in IDUs (52.2%), while cellulitis/erysipelas was more common in non-IDUs (55.9%). Most infections were due to Staphylococcus aureus (IDUs, 75.2%; non-IDUs, 85.6%), while oral pathogens were more prevalent in IDUs. Early clinical success rates for tedizolid and linezolid were 82.5% and 79.6% in IDUs and 81.3% and 79.3% for non-IDUs, respectively; responses at PTE were similar. Microbiological response per pathogen was similar between treatment groups. Rates of treatment-emergent adverse events (AEs) in IDUs were comparable between tedizolid (46.2%) and linezolid (47.8%) arms, while lower incidence of gastrointestinal AEs was observed with tedizolid (20.3%) than with linezolid (25.1%).ConclusionEfficacy and safety of tedizolid and linezolid in the treatment of ABSSSI was similar in IDUs and non-IDUs, supporting the use of oxazolidinones in treating ABSSSIs in IDUs.FundingMerck & Co., Inc., Kenilworth, NJ, USA.

Analysis of Anthrax Immune Globulin Intravenous with Antimicrobial Treatment in Injection Drug Users, Scotland, 2009-2010.

We studied anthrax immune globulin intravenous (AIG-IV) use from a 2009-2010 outbreak of Bacillus anthracis soft tissue infection in injection drug users in Scotland, UK, and we compared findings from 15 AIG-IV recipients with findings from 28 nonrecipients. Death rates did not differ significantly between recipients and nonrecipients (33% vs. 21%). However, whereas only 8 (27%) of 30 patients at low risk for death (admission sequential organ failure assessment score of 0-5) received AIG-IV, 7 (54%) of the 13 patients at high risk for death (sequential organ failure assessment score of 6-11) received treatment. AIG-IV recipients had surgery more often and, among survivors, had longer hospital stays than did nonrecipients. AIG-IV recipients were sicker than nonrecipients. This difference and the small number of higher risk patients confound assessment of AIG-IV effectiveness in this outbreak.

An Outbreak of Invasive Group A Streptococcal Infections in Injection Drug Users

An Outbreak of Invasive Group A Streptococcal Infections in Injection Drug Users

Prevention and Treatment of HIV Infection in Injection Drug Users in the Bronx

Human Immunodeficiency Virus-1 infection is prevalent among injection drug users nationwide, and is especially prevalent here in the Bronx and New York City. Injection drug users are at increased risk for acquiring and transmitting HIV infection primarily because of unsafe injection practices and high-risk sex behaviors, but several studies have tested risk reduction interventions for injection drug users and found them to decrease these risk behaviors. The most successful risk reduction interventions mobilize peers, involve community outreach, and work in conjunction with substance abuse treatment programs. Other successful interventions for reducing HIV transmission risk among injection drugs users rely on medical providers to offer individualized risk reduction along with medical treatment for HIV. In this article, we review HIV prevention and treatment programs that have helped stem the HIV epidemic among injection drug users in the Bronx.

A Cost Analysis of Hospitalizations for Infections Related to Injection Drug Use at a County Safety-Net Hospital in Miami, Florida.

BackgroundInfections related to injection drug use are common. Harm reduction strategies such as syringe exchange programs and skin care clinics aim to prevent these infections in injection drug users (IDUs). Syringe exchange programs are currently prohibited by law in Florida. The goal of this study was to estimate the mortality and cost of injection drug use-related bacterial infections over a 12-month period to the county safety-net hospital in Miami, Florida. Additionally, the prevalence of HIV and hepatitis C virus among this cohort of hospitalized IDUs was estimated.Methods and FindingsIDUs discharged from Jackson Memorial Hospital were identified using the International Classification of Diseases, Ninth Revision, codes for illicit drug abuse and endocarditis, bacteremia or sepsis, osteomyelitis and skin and soft tissue infections (SSTIs). 349 IDUs were identified for chart abstraction and 92% were either uninsured or had publicly funded insurance. SSTIs, the most common infection, were reported in 64% of IDUs. HIV seroprevalence was 17%. Seventeen patients (4.9%) died during their hospitalization. The total cost for treatment for injection drug use-related infections to Jackson Memorial Hospital over the 12-month period was $11.4 million.ConclusionsInjection drug use-related bacterial infections represent a significant morbidity for IDUs in Miami-Dade County and a substantial financial cost to the county hospital. Strategies aimed at reducing risk of infections associated with injection drug use could decrease morbidity and the cost associated with these common, yet preventable infections.

Acute infections in intravenous drug users

Mortality in injecting drug users (IDUs) is up to 22 times higher than for the age-adjusted population.1 Despite increased provision of needle and syringe programmes, reduced needle and syringe sharing, and higher uptake of hepatitis B (HBV) vaccination,2 IDUs remain vulnerable to a range of infections with potentially life-threatening complications. In this paper, we describe the epidemiology, presentation, diagnosis and management of infections in IDUs who may present to acute physicians and the management of drug dependency on acute medical wards.

Norjizak Injection: A Critical Risk for Transmitting Blood-Borne Infectious Diseases

Dear Editor, Infectious diseases including HIV and viral hepatitis constitute a major health concern with high prevalences among injecting drug users (IDUs) in Iran (1, 2). IDUs that share needles and syringes and practice sexual behaviors are at risk groups for being infected with blood-borne infectious diseases such as HCV (3). The recent increasing use of opioids in Iran has been strongly associated with health-related harms (4) including transmitting HIV, HCV, and HBV infections (5-9). In 2005, a new illicit opioid, named as Norjizak, was introduced in Iran’s illicit drug market and it gained popularity in a short period of time and contributed to transmitting blood-borne infectious diseases. Norjizak which is also written as Norjizac, Norgesic, and Norchizack in Iran is a narcotic drug which is a combination of several opioids with Dexamethason or Benzodiazepines (10). Its main route of administration is injection. Norjizak is also used intramuscularly and/or subcutaneously. Its injection is associated with several medical complications including abscess formation, development of septic emboli and soft tissue infections in IDUs, but a few studies have focused on Norjizak injection and its health-related problems in Iran (11). A recent study on the patterns of pre-treatment drug abuse, drug treatment history, and characteristics of 810 drug dependent-patients at drug use treatment clinics in Tehran, Iran showed that Norjizak injecting was prevalent as a main drug of abuse among 0.5% of the sample before entry to Methadone maintenance treatment (12). In another study on hospitalized drug users in Loghman Hakim and Imam Hussein hospitals in southern Tehran, a total of 221 patients were studied. The study results showed that 5.4% included injecting Norzijak users (INUs) (13). A research study on 18 male Norjizak-dependent patients with a mean age of 29.8 years who volunteered for treatment at a drug use treatment clinic showed various psychological and physical impacts associated with Norjizak injecting such as striae, weakness, high systolic blood pressure, moon face, hirsutism, extensive dermal infection, gynecomastia, backache, insomnia, lack of potency, and 22.2% of the sample was infected with HCV (14). In a study on infectious complications and mortality due to Norjizak injecting in comparison with other injecting opioids, 690 patients whom were admitted to a hospital in Isfahan city were studied. The study findings showed that 14.5% were INUs. Compared with other groups, Norjizak group was younger and the death rate was 37.5% which was higher than other groups (15). In a study, 14 vials of Norjizak were tested for detecting HCV. Two-hundred micro-liters of the solution in each vial were obtained and using a high pure viral nucleic acid kit, RNA extraction was done. Thereafter, C-DNA was produced by the use of Moloney Murine Leukemia Virus reverse transcriptase (Fermentas, Life Science). Using specific primers and a probe for the detection of HCV (Tagman probe), PCR was done (Corrbette Research 6000). The study results showed that 14% of the vials were positive for HCV (16). Norjizak injecting is a crucial health concern and risky behaviors related to norjizak injecting account for a considerable proportion of incident blood-borne infectious diseases such as HCV. Therefore, treatment interventions and harm reduction programs are necessary to prevent or reduce Norjizak injecting among IDUs. With reducting Norjizak injecting and consequently, decreasing the spread of blood-borne infectious diseases, these programs help both INUs and the community. There is evidence that access to Methadone maintenance treatment (MMT) could be helpful for reducing illicit drug injection and can be considered as a major intervention for preventing from transmitting blood-borne infectious diseases in Iran (17). In recent years, a harm reduction approach has been rapidly developed for IDUs in Iran. Methadone and Buprenorphine maintenance treatment programs have become widespread (18). A study on MMT outcomes in Iran showed that the prevalence of drug injection in the MMT group was lower compared with the control group (16% vs. 100%). There was also a considerable difference in needle and syringe sharing (40% in the control group vs. 4% in the MMT group) (19). In recent years, needle and syringe programs (NSPs) have been also developed to decrease sharing practices among IDUs in Iran (20, 21), but implementing specific harm reduction strategies that specifically target INUs should be considered by policymakers and health providers. The medical and health impacts of Norjizak injecting in Iran are complex and devastating, therefore, extensive research is still required to investigate the effects of Norjizak injecting on general health and transmitting blood-borne infectious diseases. Drug education on Norjizak injecting and its risks for being infected with viral infections such as HCV is essential. Norjizak injecting is a critical health concern among some Iranian IDUs that requires a collaborative and consistent response among all health providers. Treatment interventions and harm reduction programs should be specifically implemented for the current treatment needs of INUs in Iran.

Cost effectiveness of screening strategies for early identification of HIV and HCV infection in injection drug users.

ObjectiveTo estimate the cost, effectiveness, and cost effectiveness of HIV and HCV screening of injection drug users (IDUs) in opioid replacement therapy (ORT).DesignDynamic compartmental model of HIV and HCV in a population of IDUs and non-IDUs for a representative U.S. urban center with 2.5 million adults (age 15–59).MethodsWe considered strategies of screening individuals in ORT for HIV, HCV, or both infections by antibody or antibody and viral RNA testing. We evaluated one-time and repeat screening at intervals from annually to once every 3 months. We calculated the number of HIV and HCV infections, quality-adjusted life years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs).ResultsAdding HIV and HCV viral RNA testing to antibody testing averts 14.8–30.3 HIV and 3.7–7.7 HCV infections in a screened population of 26,100 IDUs entering ORT over 20 years, depending on screening frequency. Screening for HIV antibodies every 6 months costs $30,700/QALY gained. Screening for HIV antibodies and viral RNA every 6 months has an ICER of $65,900/QALY gained. Strategies including HCV testing have ICERs exceeding $100,000/QALY gained unless awareness of HCV-infection status results in a substantial reduction in needle-sharing behavior.DiscussionAlthough annual screening for antibodies to HIV and HCV is modestly cost effective compared to no screening, more frequent screening for HIV provides additional benefit at less cost. Screening individuals in ORT every 3–6 months for HIV infection using both antibody and viral RNA technologies and initiating ART for acute HIV infection appears cost effective.

Examination of the risk of reinfection with hepatitis C among injecting drug users who have been tested in Glasgow

BackgroundUnsafe injecting practices put injecting drug users (IDUs) at repeat exposure to infection with the hepatitis C virus (HCV). It has not yet been determined if spontaneously clearing one's primary infection influences the risk of reinfection; our aim was to estimate the relative risk of reinfection in IDUs who have cleared the virus. MethodsWe conducted a retrospective study using a large database of HCV test results covering Greater Glasgow Health Board during 1993–2007 to calculate rates of infection and reinfection in current/former IDUs. The relative risk of (re)infection in previously infected compared with never-infected IDUs was estimated using Poisson regression, adjusting for age at study entry, sex, and calendar period of test. ResultsAlthough the rate of reinfection in IDUs who were HCV antibody-positive, RNA-negative at baseline was lower (7/100 person-years, 95% CI: 5–9) than the rate of acute infection in IDUs who were HCV antibody-negative at baseline (10/100 person-years, 95% CI: 9–12), the risk of reinfection was not significantly different than the risk of initial infection (adjusted rate ratio=0.78, 95% CI: 0.57–1.08). ConclusionWe found only weak evidence for a reduced risk of HCV reinfection in IDUs who had cleared their previous infection. Further research among those who have cleared infection through antiviral therapy is needed to help inform decisions regarding treatment of IDUs.

Hepatitis C virus infection in the Middle East and North Africa “MENA” region: injecting drug users (IDUs) is an under-investigated population

Investigation of the injecting drug users (IDUs) population is becoming extremely critical and timely in light of the recent evidence that IDUs now act as the core of hepatitis C virus (HCV) epidemics in developed countries. The purpose of this article, therefore, is not only to review the epidemiology of HCV in the Middle East and North Africa (MENA) region, but also to see whether IDUs were adequately studied and whether harm reduction strategies to be applied for their protection have been set. A literature review was carried out of articles published within the last decade on HCV infection. The gathered data showed that the population of IDUs is severely under-investigated throughout the whole region, possibly due to religious and cultural impediments. In order to reduce the risk of HCV infection in IDUs, a set of recommendations are advanced emphasizing the urgent need for bio-behavioral studies in this population in order to help identify the source and mode of transmission and the genotypes of HCV involved. These results may allow the development of effective and, yet, socially acceptable intervention strategies. We believe that the role which IDUs play in sustaining HCV infection is also an under-investigated topic in many developing countries. Similar reviews and, hence, interventions should be initiated in these regions.

HEPATITIS C VIRUS GENOTYPES IN INJECTING DRUG USERS FROM ROMANIA.

Due to the increasing number of infections related to injecting drug use, both the pattern of hepatitis C virus (HCV) transmission, and the circulating genotypes in Europe have changed. As there are little available data in this respect for Romania, the aim of our study was a preliminary analysis of the distribution of HCV genotypes circulating among injecting drug users (IDUs). Of the 45 IDUs evaluated (86.7% men, mean age - 27.6±3.7 years, mean age at first drug use - 17.5±3.9 years), 88.9% presented anti-HCV antibodies, with higher rates in those with an injecting history of more than 10 years; 57.8% of the subjects had detectable HCV viral load. Only 6.7% had markers of chronic hepatitis B infection, and none had anti-HIV antibodies. While HCV subtype 1b is still prevalent (in 50% of the viraemic subjects), other subtypes begin to emerge, especially in younger patients (1a - in 23.1%, 4 - in 11.5%, 3a - in 7.7% of the cases). These data indicate the possibility of major shifts in the distribution of the dominant subtype, underlining the need for close surveillance of HCV infections in IDUs, who can act as a bridging group toward the general population.