Injection Drug Abuse Research Articles

Assessment of Knowledge and Attitudes Related to HIV/AIDS Among the Population With Increasing Incidence Rate.

Introduction Lack of awareness and negative attitudes towardpeople living with HIV/AIDS (PLWHA) are key barriers to minimizing the transmission of HIV. Therefore, the present survey-based study aimed to assess the knowledge regarding HIV/AIDS and attitudes toward PLWHA. Methods In the present study, we collected data from 612 Kyrgyz national participants using a self-administered questionnaire. Results Among the participants, 59% (361) were females, and 41% (251) were males. The mean age of the participants was 26.23(SD = 7.7) years. All participants were aware of HIV/AIDS, and 59.1% (362) agreed to have sufficient information about HIV/AIDS. Overall, the participants displayed a high level of knowledge about HIV/AIDS transmission, and 89.2% (546) of them were aware of sexual transmission of HIV/AIDS. Among the participants, 54% (330) believed that using condoms during sexual intercourse could prevent the transmission of HIV/AIDS. Concerning social attitudes, 17% (104) of the participants agreed that HIV-infected individuals should be isolated from society. Moreover, 39% (238) of them disagreed to work with PLWHA.The results of the study suggest that female participants were more aware of the modes of HIV/AIDS transmission than males. However, misconceptions regarding transmission routes were present in both genders. Conclusion The present study revealed that study participants had correct knowledge about HIV/AIDS transmission modes such as unsafe blood transfusionand injectable drug abuse. However, knowledge about unsafe tattooing and mother-to-baby mode of HIV/AIDS transmission was observed to be lower. Female participants were found to be more aware of HIV/AIDS transmission. There is a need to address the knowledge and awareness gap in the general population of Kyrgyzstan, especially among the male population.

Intravenous Drug Abuser Treated for Chronic Infected Open Forearm Fracture with Shortening and Primary Wound Closure

Summary: Neglected and open forearm fracture wounds accompanied by shortening are complex injuries that are seldom reported in the known literature. We describe a patient with a history of chronic intravenous drug abuse (IVDA) and a neglected forearm wound with radius and ulna fractures with chronic osteomyelitis managed by limb salvage. The patient had a history of IVDA and a neglected forearm wound with fractures in both the radius and ulna, along with chronic osteomyelitis. The approach taken to manage this complex injury involved limb salvage. The case emphasizes the treatment challenges associated with patients who had IVDA and neglected their wounds. Thorough evaluation combining clinical and radiological assessments, followed by appropriate surgical planning and intervention, played a crucial role in restoring the functional status of the limb. Neglected open fracture wounds in the forearm are uncommon and have limited documentation in the existing literature. The described patient’s chronic history of IVDA and the disregarded open forearm osteomyelitis exemplify the severe consequences that can arise from injectable drug abuse in the upper extremity. In such cases, limb preservation and optimization of functional outcomes become paramount. To the best of our knowledge, this is one among the few reported cases of this nature, highlighting the significance of sharing such experiences to enhance medical understanding and inform future treatment approaches.

Kampanye No Drugs Untuk Mencegah Resiko Penularan HIV/AIDS

Introduction: Drug abuse is closely related to crime, traffic accidents and is currently at the stage of transmission of the HIV/AIDS virus. The sharp increase in HIV prevalence among injecting drug users is caused by the use of unsterile needles and syringes coupled with the practice of group injection. Various efforts to control and prevent drugs and HIV/AIDS have been carried out, one of which is to empower the potential and knowledge of youth through youth organizations. Objective: to implement and increase knowledge to be directly and actively involved in the prevention of drug abuse and eradication in order to avoid and prevent the risk of HIV-AIDS transmission. Method: The methodology used is that this consultation is based on strategy, implementation and action, and ends with an assessment conducted at the end of the update, using the number of surveys available to the community according to the required survey needs. Result: The implementation of socialization of the dangers of drugs and the risk of HIV-AIDS to Wibawa Mukti youth organizations in Ciharalang village gave significant results because increasing youth knowledge about the dangers of injecting drugs has a role in encouraging the participation of all elements of the local community to avoid drug use. Conclussion: The implementation of socialization of the dangers of drugs and the risk of hiv-aids to youth youth organizations in the village of ciharalang gave significant results because increasing youth knowledge about the dangers of injecting drug abuse has a role in encouraging the participation of all elements of the local community to avoid drug use.

Clinico-epidemiological Aspects of Cutaneous Lesions in Injecting Drug Users Visiting an Oral Substitution Therapy Centre in Northern India: A Cross-Sectional study.

Drug abuse has been taking a great toll on the health and well-being of the community for the past few decades. Substance abuse can lead to several cutaneous manifestations as direct injuries by the offending drug or the practices of drug usage cause secondary damage to the skin. The early recognition of these signs is of utmost importance to prevent long-term complications. To study the clinical-epidemiological profile of the skin diseases in Injecting Drug Users (IDU) attending an Oral Substitution Therapy (OST) Center in Northern India and to assess the psychological impact of skin conditions in IDUs attending OSTs. This cross-sectional observational study involved 100 IDUs enrolled from the OST center who were subjected to brief history taking and clinical and dermoscopic evaluation of skin lesions. Dermatological quality of life index (DLQI), Depression, Anxiety, Stress Scale (DASS), and WHO-quality of life (QoL) questionnaire were used to evaluate the impact of skin lesions on psycho-social health and QoL of IDUs. Cutaneous lesions ranged from track marks to severe ulcerations and scarring. Mucosal lesions also took a toll on several patients. The patients had varying degrees of anxiety, depression, and mental stress. Injecting Drug Abusers are prone to acquire skin diseases due to injury caused by drugs as well as by drug practices adopted and the degree of neglect may worsen these conditions. These cutaneous lesions hamper QoL and cause psychosocial disturbances.

Management of hepatitis B and C in special population.

Chronic viral hepatitis is one of the leading causes of cirrhosis worldwide. Chronic hepatitis B is more common in the Asia-Pacific region due to the larger population and lower screening availability. Hepatitis C predominates in the west due to injection drug abuse. The discovery of (oral) direct-acting antiviral agents (DAAs) has changed the landscape of chronic hepatitis C (CHC) management. Nucleos(t)ide analogs (NUCs) have also changed the approach to the treatment of chronic hepatitis B (CHB). Oral NUCs and DAAs have excellent efficacy and patient acceptance as well as a lower risk of resistance. However, certain populations have no robust data and safety and efficacy of such oral drugs is still evolving. In this review, we provide an overview of the management of CHB and CHC in special populations, such as those with chronic kidney disease, pregnant women, healthcare workers, and those undergoing chemo- or immunosuppressive therapy.

Fatality due to unusual femoral vein rupture in an injectable drug user

Drug addiction is an ever-increasing evil in society. Injectable drug users have a high risk of complications. There is a wide variety of presentations and complications of such addiction cases. Deaths are reported in drug users most frequently due to acute intoxication/overdose and related complications. Intravenous drug intake leading to rupture of a vein is seldom reported in the literature. We report a rare case in which a drug addict collapsed after a burst of drug kit following injection into his right thigh and died. The authors aim to highlight and spread awareness in society about such unknown uncommon accidental dangers associated with injectable drug abuse which could be fatal. The authors also aim to aid to Medical Literature such rare episodic occurrences which could cause fatality in drug users.

Morphological features of jaw osteonecroses in injectable drug abuse

To determine the characteristic features in the structure of jaw bone sections in patients with jaw osteonecrosis caused by the use of homemade methamphetamine (HM) synthesized by the Nagai method. The investigation material was jaw sequesters and resected sections in 60 patients, which had been taken during sanitizing surgery for chronic odontogenic osteomyelitis (Group 1, n=30, a comparison group) and jaw osteonecrosis (Group 2, n=30). All the patients in Group 2 confirmed that they had been using HM for at least 2 years. The investigation material was selected only from the patients who had not been found to have congenital or acquired immunodeficiencies or multiple organ failure phenomena. The material was fixed according to the standard procedure; the sections obtained were stained with hematoxylin and eosin and Masson-Goldner. Morphometry used the indicators proposed by the American Society of Bone and Mineral Research Histomorphometry Nomenclature Committee, as well as 6 author parameters. The findings of the investigation were statistically processed using the Statistica 10.0 program (StatSoft, USA) by the nonparametric Mann-Whitney test. The histoarchitectonics of the mandible bone matrix represented a destructured devitalized tissue complex on the mandibular microspecimens taken from a group of patients with chronic odontogenic osteomyelitis of the jaws. The state of the bone matrix was characterized by the atypical rearrangement with the phenomena of sclerosis, the signs of primary aseptic inflammation with toxic vasculopathy and fibrinoid necrosis, as well as those of secondary pyonecrotic inflammation on the mandibular microspecimens taken in the HM group. The characteristic morphological pattern of jaw osteonecrotic injuries in persons with HM-induced drug abuse is the simultaneous identification of two types of lesions: a primary lesion as aseptic ossifying osteitis and a secondary lesion as pyonecrotic inflammation. The phenomena of toxic vasculopathy and fibrinoid osteonecrosis can serve as one of the criteria confirming the active regular intake of HM.

Prevalence and Risk Factors Associated with Hepatitis B and C in Nawabshah, Sindh, Pakistan

In Pakistan, viral hepatitis is a serious public health problem affecting millions of people. Both hepatitis B and hepatitis C infections are spreading rapidly in all provinces of Pakistan, including Sindh, because of lack of knowledge about routes of transmission, low literacy rate, reuse of syringes, piercing, and other factors. However, information about the prevalence and risk factors is inadequate. So, a general population-based study was conducted to determine the prevalence rate and risk factors of hepatitis B and hepatitis C in Nawabshah. Healthy individuals were screened for hepatitis B and hepatitis C using an immunochromatographic rapid test followed by confirmation through ELISA and PCR. Information about sociodemographic and risk factors was obtained through a pretested questionnaire. Descriptive frequencies, odds ratio, and CI were calculated using SPSS software version 23 (IBM Corp, Armonk, NY). In total, 523 participants were screened for hepatitis B and hepatitis C, among whom 232 were females and 291 were males. The overall prevalence of hepatitis C and hepatitis B was 14.3% and 6.7%, respectively. In a bivariate analysis, hepatitis B infection was significantly associated with risk factors such as hospitalization, blood transfusion, needle injury, multiple sex partners, reused syringe, dental extraction, surgery, injectable drug abuse, and shaving at barbershops. Hepatitis C infection was associated with factors including surgery, needle injury, blood transfusion, reused syringes, dental extraction, and shaving at barbershops. The increasing prevalence of hepatitis B surface antigen and hepatitis C virus in Nawabshah is a public health concern. There is dire need to implement preventive measures.

Presentations of the Injection Drug Users in an Emergency of a Surgical Unit of a Tertiary Care Hospital of Pakistan

Background: Drug Abuse is a growing concern in whole world and in Pakistan we are seeing increasing number of people using drugs. There is growing shift towards injection drug abuse. Young generation is falling victim to Injection drug abuse which not only poses serious medical concerns but also present as life threatening emergencies on surgical floor. We have been seeing increasing number of people coming with ruptured pseudo aneurysms on surgical floor with resultant life-threatening hemorrhage for the patient and putting healthcare providers too at risk of getting various infectious diseases like HIV. Objective: The aim was to study the different presentations of injection drug users in surgical emergency and assess the seroprevalence of viral infections and factors associated with injection drug use. Study Design: Retrospective study. Settings: The study was conducted in west surgical ward King Edward medical university Lahore-Pakistan. Duration: Six months from 01-01-2019 to 01-06-2019. Methodology: data of all the injection drug users presenting in surgical emergency was collected. This comprised their sociodemographic profile, presenting disease and blood tests for HIV, Hepatitis B and Hepatitis C virus infections. Results: The mean age of patients was 31 years. Majority (47 %) belonged to Lahore, 21% from Gujranwala and 16 % from Sialkot. Majority (89.5%) had poor socioeconomic status. All patients were males. Majority (63.2 %) were single and illiterate (73.7%). In all the patients route of injection was femoral. Regarding viral serology 84.2 % patients were HIV positive ,15.8% patients were positive for both HIV and HCV. Patients presented with three surgical problems; Ruptured Femoral pseudoanuerysms (42.1%, n=8), Abscesses (31.6 %, n=6), Fournier’s gangrene (26.3 %, n= 5). In all femoral Psuedoanuerysms external iliac artery was ligated. Abscesses were incised and drained. Fournier’s gangrene was debrided with exposure of the testes. Conclusion: The Government should control illegal drug usage, educate the masses through print and electronic media to raise awareness of growing epidemic of HIV and to provide resources to made dedicated centers for surgical emergencies of these patients.

Injection of oral medication into the skin confirmed by infrared spectroscopy

"Skin popping" refers to the practice of injecting drugs, most commonly heroin, subcutaneously or into granulation tissue. Pharmaceutical tablets meant for oral consumption are modified into solutions for injection. Excipients-inactive substances that serve as vehicles for medication-are often not filtered out before injection and result in abscess formation, granulomatous inflammation, and scarring. Common excipients used in the production of pharmaceutical tablets include starch, microcrystalline cellulose, magnesium stearate, silica, and polyvinylpyrrolidone (PVP). Identification of these exogenous materials is valuable in confirming the diagnosis of skin popping, especially when patients may not be forthcoming about their drug use. We present a case of subcutaneous oral medication injection in which PVP and cellulose were identified by Fourier transform infrared spectroscopy. Considering the variable cutaneous manifestations of injection drug abuse, recognition of histopathologic and chemical characteristics of exogenous material from oral medications is helpful for diagnosis and intervention.

Psychological and Social Determinants of HIV: Path Analysis Evidence from Jepara, Central Java

Background: HIV/AIDS was a global problem as a challenge in health discipline and a very important burden of disease to be addressed. Moreover, it had high mortality. This study aimed to analyze the risk factors for HIV/AIDS infection. Subjects and Method: This was a case control study conducted in Jepara, Central Java, from April to May 2019. A sample of 200 study subjects was selected by fixed disease sampling. The dependent variable was HIV/AIDS. The independent variables were age, gender, unsafe sex behavior, sexual orientation, frequency of intercourse, injection drug abuse, social capital, perceived susceptibility, perceived seriousness, perceived threat, self-efficacy, and geographical location. The data were obtained from medical record and questionnaire. The data were analyzed by path analysis . Results: HIV / AIDS had a direct relationship with the frequency of sexual intercourse (b= 1.23; 95% CI= 0.27 to 2.19; p= 0.012), injecting drug use (b = 2.19; 95% CI= 0.01 to 4.37; p= 0.049), behavior unsafe sex (b= 3.10; 95% CI= 2.21 to 3.99; p <0.001), and sexual orientation (b= 3.69; 95% CI= 1.35 to 6.04; p= 0.002). HIV / AIDS had an indirect relationship with perceptions of threats, gender, geographical location, social capital, perceptions of vulnerability, perception of seriousness, self-efficacy, and age. Conclusions: HIV / AIDS has a direct relationship with the frequency of sexual relations, sexual orientation, unsafe sexual behavior, and injecting drug use. HIV / AIDS has an indirect relationship with age, gender, perception of vulnerability, perception of seriousness, perception of threats, self-efficacy, social capital, and geographical location. Keywords : HIV / AIDS, sexual behavior, social capital, path analysis Correspondence : Ita Fijanah Puspita, Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: itapuspita713@gmail.com. Mobile: 081347970482. Journal of Health Promotion and Behavior (2019), 4(1): 43-54 https://doi.org/10.26911/thejhpb.2019.04.01.05

Pneumococcus a Rare Cause of Cellulitis

Streptococcus Pneumoniae (S. pneumoniae) is a common cause of community-acquired pneumonia, although its manifestation as a skin infection is a rare phenomenon. Most skin infections are secondary to Staphylococcus aureus or Streptococcus pyogenes, however, cellulitis caused by pneumococci is an infrequent finding. Pneumococcal cellulitis most often occurs due to bacteremia in patients with chronic illnesses such as diabetes, underlying malignancies, immunosuppressed patients, and patients with the history of injection drug abuse. The nature of the infection can be very fatal leading to fasciitis, myonecrosis, septic shock and ultimately death. We present a case of a 61-year-old female who developed painful swelling and redness of the right face along with bilateral leg involvement. In the emergency room, physical examination revealed multiple cervical lymphadenopathies. Further diagnostic investigations disclosed Low-grade B-cell non-Hodgkin lymphoma upon cervical lymph node biopsy. Blood culture grew Streptococcus pneumoniae as a source of cellulitis. This case demonstrates the importance of immune defects and the ensuing development of pneumococcal-induced cellulitis. Physicians should be vigilant while treating Pneumococcal cellulitis as this may be a sign of the serious underlying medical condition.

Is black tar heroin use associated with wound botulism? A report of two Hispanic patients.

Key Clinical MessageWound botulism is a potentially lethal condition that can cause paralysis. Its association with black tar heroin is a well‐established fact. It is essential to alert clinicians in recognizing the patients with history of injection drug abuse presenting with clinical features of botulism early on admission for prompt diagnosis and treatment.

Evaluation of supervised injection facilities as an ethically sound approach to treatment of injection drug abuse

Novel approaches are needed to address the issue of injection drug use in Canada, which can have negative consequences for drug users and society. Supervised injection facilities (SIFs) are legally sanctioned facilities in Canada where drug users can receive sterile drug paraphernalia, referral to cessation programs and timely medical care if necessary. SIFs operate under the principle of harm reduction, which aims to reduce rates of infection and death due to overdose among drug users. SIFs are largely driven by the utilitarian ideal of maximizing benefit for the greatest number of people, through supervision of active drug users and appropriate referral for those wishing to quit. Deontological theory may support SIFs depending on how one applies the categorical imperative. Studies of the first SIF in North America, Insite, have shown demonstrable reductions in adverse health and societal consequences of injection drug use, rationalizing their implementation under consequentialism. SIFs are, therefore, suitable for greater adoption by the healthcare system.

Why don’t key populations access HIV testing and counselling centres in Nepal? Findings based on national surveillance survey

ObjectivesTo assess the demographic, behavioural, psychosocial and structural factors associated with non-utilisation of HIV testing and counselling (HTC) services by female sex workers (FSWs) and men who have sex with...

HIV/AIDS risk behaviors among injecting drug users: Addressing development of risk behavior knowledge and patterns of risk behavior practices in context of demographic characteristics

Objectives: The present study is aimed to investigate patterns of HIV/AIDS risk behaviour practices (sexual and syringe sharing) among injecting drug users by addressing; 1. Factors effecting acquisition of risk behaviour knowledge, and 2. Demographic and psychosocial characteristics influencing practice of risk behaviour knowledge. Design: This is a cross sectional study, patients admitted for treatment and rehabilitation from injecting drug abuse, were interviewed and statistical testing was conducted using SPSS 10.1 to identify critical factors of risk behaviour practices. Material and Method: 149 male injecting drug users were included in the present study; females were excluded due to insignificant representation. Patients were interviewed on a self-developed structured questionnaire for demographic and psychosocial characteristics and another structured questionnaire was used to obtain level of risk behaviour knowledge and frequency of risk behaviour practices. Place and Duration: The study was conducted at Model Drug Abuse Control Center (MDACC), a subdivision of Department of Psychiatry and Behavioural Sciences, Bahawal Victoria Hospital, Bahawalpur, a teaching hospital affiliated with Quaid-e-Azam Medical College. Results and Discussion: Present study investigated HIV/AIDS risk behaviour practices in injecting drug users. Results showed that only two sources of knowledge Television and Print Media significantly influenced acquisition of risk behaviour knowledge (p=0.05). Among demographic characteristics, of IDUs and their access to sources of knowledge, only socioeconomic status (p=0.01) and education (p=0.001) were associated with access to sources of knowledge. Finally, the study concerns with differences in demographic characteristics and their association to risk behaviour practices. Post Hoc analysis of demographic characteristics showed that only middle level of education predicted low syringe sharing risk behaviours with (Mean difference = -1.19, P =0.03). Sexual risk behaviour was predicted by marital status and Living status. Patients living alone showed higher levels of risk behaviour practices than patients living with parents (Mean difference = 1.61, P = 0.001) and patients living with family (Mean difference = 1.31, P =0.02). In addition, high frequency of injections predicted higher levels of risk behaviour practices. Conclusion: The study reveals some flaws in HIV/AIDS risk behaviour preventions programs, as more access to channels of sources didn’t predict low risk Behaviour. Serious efforts are required in awareness campaigns by considering specific needs of injecting drug users.

Assessment of seroprevalence of hepatitis C virus-specific antibodies among patients attending hospital of semiurban North India using rapid qualitative in vitro diagnostic test

Background and Objectives: Hepatitis C virus (HCV) is an important cause of blood-borne viral hepatitis throughout the world. Acute infection is usually silent and detected on the basis of raised liver enzymes and antihepatitis C antibody in patient's serum. Chronic infection may lead to hepatocellular carcinoma and liver cirrhosis. The present study was done to evaluate the seroprevalence of anti-HCV antibodies among patients using rapid qualitative in vitro diagnostic test. Materials and Methods: A total of 1,076 patients' blood samples were taken for testing antiHCV antibodies using rapid in vitro diagnostic test kit. Results: Out of 1,076 patients whose sera were tested, 18 were found to be reactive to antihepatitic C virus antibody giving the prevalence to be 1.7%. Out of 18 reactive patients majority belonged to inpatient department (88.9%) as compared with outpatient department (11.1%). Majority of the reactive patients belonged to age group 26-35 years (72.2%), were from rural areas (83.3%), were illiterate (77.7%), were skilled workers (66.7%), and belonged to socioeconomic class 3 (55.5%). Among the reactive patients, the most frequent risk factor for antihepatitis C antibody was found to be history of injecting drug abuse and tattooing and body piercing (22.2% each). Conclusion: Hepatitis C infection is usually a silent disease and therefore stringent screening for antihepatitis C antibody should be done in all patients using rapid in vitro diagnostic kits in order to timely diagnose the infection and initiation of treatment, thereby, preventing its adverse sequelae and also its spread to other patients.

Successful control of a large outbreak of HIV infection associated with injection of cathinone derivatives in Tel Aviv, Israel

ObjectivesOutbreaks of HIV infection have been linked to injectable drug abuse, but specific triggers often remain obscure. We report on an outbreak of primary HIV infection among people who inject drugs (PWID) in Tel Aviv, associated with a local shift in drug-use practices. MethodsA cluster of primary HIV infection cases in PWID was detected in May 2012. Retrospective and prospective multi-hospital case finding was initiated. PWID were interviewed and risk factors for primary HIV infection were identified. Starting in December 2012, a multifaceted intervention was implemented, including educational activities, increasing syringe exchange supplies, active screening, early initiation of antiretroviral therapy, and referral to drug withdrawal programmes. ResultsForty-two PWID with primary HIV infection were detected between May 2012 and April 2013. Compared with the corresponding pre-outbreak period, the annual incidence of primary HIV infection in PWID increased from 0 to 20 cases/1000 population (p <0.0001). Sixty-nine per cent were hospitalized because of concomitant bacterial infections and sepsis. Phylogenetic analysis of HIV isolates from case patients showed tight clustering suggesting a single common source of infection. The outbreak was temporally related to a widespread shift from heroin to injectable cathinone-derivatives and buprenorphine, which entailed high-risk injection practices. Targeted intervention resulted in a dramatic and sustained reduction in HIV infection in the PWID population. ConclusionsInjectable amphetamines are gaining momentum among PWID worldwide. Tracing of this outbreak to cathinone use and implementing a targeted intervention programme effectively terminated the outbreak.

HIV/AIDS Risk and Prevention Issues Among Inuit Living in Nunavut Territory of Canada.

HIV infections occur across the Arctic but their incidence among aboriginal populations varies vastly. At the time this research was initiated there were no data on their occurrence, risk of HIV/AIDS or preventive strategies among Inuit living in the Nunavut territory of Canada. This review is the first to assess the risk of HIV infection among Inuit and evaluate current prevention strategies among Canadian-Inuit populations. The contents of this article are based on the author's own research, undertaken during 3 visits to the Canadian Arctic and the published literature. Disproportionately high rates of Chlamydia and Gonorrhoea within Inuit communities confirm the potential threat of silent HIV transmission. Inuit awareness of HIV/AIDS issues remains inadequate. It is easy to blame distorted perceptions fuelled by the media, religious influence and socio-cultural factors. Aboriginal and Inuit groups, including youth, women and injection drug abusers are at increased risk of infection. The adaptability of proven prevention methods including condom use and male circumcision are discussed. Access to treatment, adherence and resistance issues in the North Canada, require attention. HIV/AIDS poses a considerable threat to Canadian Inuit public health. The most important problem to be addressed is Inuit lack of awareness and understanding of HIV. Education is the single most effective means of prevention. Inuit-specific and culture-sensitive interventions are recommended. Further research opportunities exist to investigate Inuit understanding over HIV/AIDS issues and to assess local prevention efforts.

Use of non-antiretroviral drugs among individuals with and without HIV-infection: a Danish nationwide study

Aim: We investigated the use of non-antiretroviral drugs in the HIV-infected compared to the general population.Methods: From the Danish HIV Cohort Study, we identified all HIV-infected individuals older than 18 years at HIV diagnosis who received care in Denmark through 1995–2013 and reported no injection drug abuse or hepatitis C infection. Population controls were identified from The Danish Civil Registration System and matched on age and gender (5:1). We analyzed the proportion of individuals who redeemed 0–1, 2–4, 5–9, or 10 or more non-antiretroviral drugs. Data were analyzed according to calendar time, age, time from initiation of combination antiretroviral therapy (cART) and stratified by gender, geographical origin and route of HIV transmission. We further analyzed the use of the 25 most used non-antiretroviral drug classes.Results: We identified 4,928 HIV-infected individuals (median age: 37; 76.4% males). Overall, the HIV-infected population had a higher use of non-antiretroviral drugs compared to the background population. Whereas, the use of non-antiretroviral drugs in the HIV-infected population only changed marginally with time, the use in the background population increased considerably. Thus, use in the HIV-infected population only differed marginally from that of the background population in recent years. This difference was most pronounced in men who have sex with men (MSM).Conclusion: Compared to the background population, HIV infected individuals have increased use of non-antiretroviral drugs. The excess use is mainly observed in MSM and has decreased with calendar time, why it in recent years only differs marginally from that observed in the background population.