Male Intravenous Drug Users Research Articles

An Unorthodox Vascular Surgical Approach to Save a Limb

A 33 year old male intravenous drug user was referred urgently with right groin haemorrhage and acute limb threatening ischaemia after superficial femoral artery (SFA) puncture. A ruptured SFA pseudoaneurysm was detected by colour duplex ultrasonography. Young age, synchronous presence of abscess (Pseudomonas aeruginosa isolates), extensive tissue damage, and lack of appropriate venous conduit favoured an end to end anastomosis (A and B, asterisk) of the profunda femoral artery (PFA) to the distal SFA stump. Meropenem was administered for 21 days and a vacuum assisted closure device helped with wound healing. Using this provocative technique, successful revascularisation and lower limb salvage were achieved.Image 1

The Clinical Characteristics and Incidence of Pulmonary Tuberculosis of 7632 HIV Patients in Yunnan Province from 2005 to 2017

Objective: To analyze the age and gender distribution characteristics of 7,632 HIV/AIDS patients at the onset of HIV infection-related high-risk intravenous drug abuse and sexual contact in Yunnan province. Methods: Data were collected from the database of Chinese Medicine Treatment of AIDS Pilot Project in Yunnan province. Gender, age and demographics of HIV/AIDS patients were analyzed. Results: The patients were almost in relatively high educational background. The number of male intravenous drug users (12.90%) was more than female, and the earliest average age was 10-14 years. The percentages of men in 10-19 years and 35-59 years were more than that of women. No obvious difference was found in heterosexual sexual contact in both men (48.11%) and women (51.89%), and the earliest ages was 15-19 years in males and 10-14 years in females. The percentage of males at 10-34 years old was less than that of females, just opposite to the age of 35-85 years. Homosexual contact was more in males (92.73%) than that in females (7.27%). The earliest homosexual sexual contact associated with HIV infection was 15-19 years in males and 25-29 years in females. Among 128 AIDS patients with pulmonary tuberculosis infection, intravenous drug abuse accounted for the highest proportion (76.56%) of the three high-risk behaviors related to HIV infection. Conclusions: Reducing risk behaviors and preventing intravenous drug abuse could be effective in preventing AIDS. Compared with other high-risk behaviors, patients with intravenous drug use and AIDS are at greater risk of contracting tuberculosis.

Hepatitis C continuum of care: Experience of integrative hepatitis C treatment within a human immunodeficiency virus clinic in Indonesia.

Direct-acting antiviral drugs (DAAs) have changed the paradigm of hepatitis C therapy for both HCV/HIV co-infected and HCV mono-infected patients. We aimed to describe the HCV continuum of care of HIV-infected patients treated in an HIV clinic after a free DAA program in Indonesia and identify factors correlated with sofosbuvir-daclatasvir (SOF-DCV) treatment failure. We did a retrospective cohort study of adult HIV/HCV co-infected patients under routine HIV-care from November 2019 to April 2020 in the HIV integrated clinic of Cipto Mangunkusumo Hospital, Jakarta, Indonesia. We evaluated some factors correlated with sofosbuvir-daclatasvir treatment failure: gender, diabetes mellitus, previous IFN failure, cirrhosis, concomitant ribavirin use, high baseline HCV-RNA, and low CD4 cell count. Overall, 640 anti-HCV positive patients were included in the study. Most of them were male (88.3%) and former intravenous drug users (76.6%) with a mean age of 40.95 (SD 4.60) years old. Numbers and percentages for the stages of the HCV continuum of care were as follows: HCV-RNA tested (411; 64.2%), pre-therapeutic evaluation done (271; 42.3%), HCV treatment initiated (210; 32.8%), HCV treatment completed (207; 32.2%), but only 178 of these patients had follow-up HCV-RNA tests to allow SVR assessment; and finally SVR12 achieved (178; 27.8%). For the 184 who completed SOF-DCV treatment, SVR12 was achieved by 95.7%. In multivariate analysis, diabetes mellitus remained a significant factor correlated with SOF-DCV treatment failure (adjusted RR 17.0, 95%CI: 3.28-88.23, p = 0.001). This study found that in the HCV continuum of care for HIV/HCV co-infected patients, gaps still exist at all stages. As the most commonly used DAA combination, sofosbuvir daclatasvir treatment proved to be effective and well-tolerated in HIV/HCV co-infected patients. Diabetes mellitus was significant factor correlated with not achieving SVR12 in this population.

Necrotizing Fasciitis Causing Complete Femoral Vessels Necrosis and Thrombosis in an Intravenous Drug Abuser: A Case Report

Background: Intravenous drug abuse is an anciently known health and social problem worldwide. The nonsterile application of addicting drugs leads to severe life-threatening vascular complications. The femoral triangle is an easy target for this purpose. Groin necrotic fasciitis (NF) with vessel necrosis is a challenging diagnosis that requires prompt treatment. Case Report: A 44-year-old male intravenous drug user presented for a left groin pain. He was diagnosed by computed tomography scan to have necrotizing fasciitis. Urgent debridement was performed and identified infected and necrotic ruptured femoral vessels without active bleeding. Debridement with vessel ligation was performed, and delayed revascularization was planned. The patient was admitted six weeks later with a left fifth toe necrosis and delayed arterial revascularization was performed via extra-anatomic trans-obturator ilio-femoral anastomosis. The patient had a favorable follow-up. Conclusion: NF in intravenous drug abusers should always be taken into consideration when a patient presents with groin pain and swelling. Urgent surgical control should be established. Extra-anatomical trans-obturator ilio-femoral anastomosis is a good option for revascularization.

Human T-cell lymphotropic virus 1/2 and human immunodeficiency virus antibodies identification among transactional sex workers and drug users in the Dominican Republic.

Human immunodeficiency virus (HIV) increases the risk of acquiring human T-cell lymphotropic virus (HTLV) and subsequently HTLV's progression to tropical spastic paraparesis/HTLV-1-associated myelopathy (TSP/HAM). Existing data have exclusively reported generalized rates of HIV and HTLV-1 chronic viral infections in the Dominican Republic. To our knowledge, no published studies have focused on the rates of HTLV-1/2 in transactional sex workers and drug users, both higher risk groups, in the Dominican Republic. From December 2012 to April 2013 we conducted a study to estimate the seroprevalence of HTLV-1/2 immunoglobulin G (IgG) and HIV antibodies among transactional sex workers and intravenous drug users in Santo Domingo, Dominican Republic. Serological status was analysed with behaviour and demographic data. We collected and analysed plasma from 200 participants with a mean age of 27.4 y in men and 25.2 y in women. The overall weighted seroprevalence of HTLV-1/2 IgG antibodies was 13.91% (95% CI 7.59 to 20.23) in men and 10.59% (95% CI 4.05 to 17.13) in women. The overall weighted seroprevalence of HIV-1 was 13.91% (95% CI 7.59 to 20.23%) in men and 17.65% (95% CI 9.55 to 25.75) in women. Male intravenous drug users had an exceptionally high rate of HTLV-positive HIV co-infection, at 75% (95% CI 44.99 to 105.01). Although there an association has been found between HTLV/HIV co-infections and sex work, the adjusted odds revealed a confounding role of HIV infection. The results highlight the urgent need for enhanced public health preventive strategies among high-risk populations in the Dominican Republic and other resource-constrained Caribbean settings, as well as global adoption of routine screening for HTLV-associated infections, particularly in these high-risk, underserved populations.

Adherence to antiretroviral therapy in HIV-positive, male intravenous drug users in Pakistan.

Human immunodeficiency virus (HIV) is fifth leading cause of mortality and disability among infectious diseases worldwide. HIV burden is increasing annually and compliance with antiretroviral therapy (ART) is low among intravenous drug users, especially in developing countries. To determine the adherence level to ART among HIV-positive intravenous drug users in Karachi Pakistan. A cross-sectional study was conducted in 2015. A pretested questionnaire was administered to 375 of 3000 people who inject drugs, registered at the Civil Hospital in Karachi, Pakistan. The mean age was 30 years, 181 were married, 179 were illiterate and 287 had income < 5000 rupees per month. Only 63 patients were adherent to ART and 343 were alcoholics. Nonadherence was greater in patients who were single and did not have children. The most common reason for missing ART was that they simply forgot to take the tablets. We conclude that adherence to ART among intravenous drug users was low. Family cohesion and support were essential to maintain adherence to ART.

Changes in the epidemiology and distribution of the hepatitis C virus genotypes in North-Eastern Spain over the last 35 years

BackgroundGenotypic distribution and epidemiology of HCV infection in Western Europe countries has changed over the last decades. AimTo establish the local genotypic profile and characterize the associated demographic variables. Material and methodAll the genotyping from 1988 to 2015 were considered. Associated demographic variables were included in logistic regression models. Genotyping was carried out with updated commercial kits. ResultsGenotype 1b was the most prevalent (42.4%) followed by 1a (22.5%), 3 (18.6%), 4 (10.6%) and 2 (4.6%). The prevalence of 1a was higher in males, in patients younger than 45 and in intravenous drug users (IDU). 1b was more frequent in older than 45, with transfusion-associated and parenteral/nosocomial infections and in immigrants from Eastern Europe. Genotype 2 was highly prevalent in the postransfusional route (54.9%). Genotype 3 prevalence was high in males, in patients younger than 45, in IDU (69.3%) and in Asian and Eastern European immigrants. Genotype 4 was high in males, in patients younger than 45, and in IDU (63.5%). 1a, 3, 4 were the most prevalent genotypes in HIV-coinfected patients. There was a significant decline in genotype 1b and an increase in genotypes 3 and 4 over time. ConclusionsThere has been a decline of genotype 1b, associated with transfusion or parenteral/nosocomial infections, and increases in the prevalence of genotypes 1a, 3 and 4 associated with male gender and IDU, now the most prevalent infection route. Immigration contributed with genotype 2 infections from Africa and genotype 1b and 3 infections from Eastern Europe and Asia.

Challenges and Successes of Harm Reduction Services in Drop-in Centers: Perspectives of Service Providers

Background: In Iran, the most common mode of HIV transmission among male intravenous drug users is sharing injection needles and syringes.Harm reduction initiatives, as a way of reducing the burden of this problem , are a set of policies and programs which attempt primarily to reduce the adverse health, social, and economic consequences of substances to drug users, their families, and communities. Objectives: The objective of this study was to elucidate the challenges and successes of HIV/AIDS services delivery as perceived by senior officials and service providers. Patients and Methods: Face-to-face, semi-structured interviews were conducted in Shiraz, Iran with a purposive sample of sub-national service providers. A thematic analysis of these qualitative data was conducted by the authors. Results: Participants identified major challenges and successes of HIV/AIDS services delivery. Service delivery and accessibility, in terms of challenges and successes, were classified. Conclusions: Our study demonstrates that, despite greater availability of HIV/AIDS services, this availability is not associated with greater accessibility and utilization because of multiple, complex, and interrelated barriers to HIV/AIDS service provision at the service delivery level.

Percutaneous treatment of severe transvalvular and paravalvular regurgitation in a failing surgical aortic valve prosthesis due to recurrent endocarditis

R.K.B is proctor for Boston Scientific and consultant for Edwards Lifesciences. F.N is consultant for Edwards Lifesciences, Medtronic, St. Jude Medical and Direct Flow Medical. F.M is a consultant for Abbott Vascular, St. Jude Medical, ValtechCardio, and Medtronic; receives royalties from Edwards Lifesciences; and is a cofounder of 4Tech. A 45-year-old male intravenous drug user known for human immunodeficiency virus infection and chronic hepatitis-C was admitted due to shortness of breath. Seven months before this admission he had undergone urgent surgical aortic valve replacement with a bioprosthesis (Edwards Perimount Magna 23 mm; Edwards Lifesciences, Irvine, California, USA) due to destructive Serratia marcescens endocarditis. Echocardiography showed new severe …

Common haplotypes in CD209 promoter and susceptibility to HIV-1 infection in intravenous drug users

IntroductionCD209 is a receptor expressed in the dendritic cells involved in recognition of oligosaccharides present in several pathogens with a relevant impact on human health. SNPs located in the promoter region have been associated with HIV-1 susceptibility, although this finding has not been replicated in other populations. The objective of this study is to evaluate the association of CD209 promoter haplotypes with risk of HIV-1 infection in a cohort of Spanish male intravenous drug users (IDU) infected with hepatitis C virus (HCV) and to characterize the phenotypic effects of the associated variants. MethodsWe genotyped 4 SNPs of CD209 promoter in 295 HCV males exposed to HIV-1 infection by IDU, 165 HIV-1-infected and 130 exposed uninfected (EUI) and 142 healthy controls (HC). We have cloned the promoter variants in a reporter vector and evaluated the promoter activities in a cell culture model. CD209 mRNAs were measured in PBMC. ResultsSingle-marker analysis revealed no significant allelic association with the risk of HIV-1 infection by parenteral route. Nevertheless, one haplotype was significantly overrepresented in EUI compared with HIV-1 positive patients and was associated with HIV-1 status (P=0.0008; OR: 0.43). Functional experiments suggested that the protective haplotype displayed lower transcriptional activity in vitro (P<0.05) and this was correlated with lower CD209 mRNA expression in PBMC (P=0.014). ConclusionsThis study suggests that the promoter haplotypes of CD209 influence the risk of HIV-1 acquisition in IDU and that this association is correlated with the mRNA expression level.

Near-Full-Length Genome Sequences of a Novel HIV-1 Circulating Recombinant Form, CRF01_AE/B'/C (CRF78_cpx), in Yunnan, China.

We report a novel HIV circulating recombinant form (CRF78_cpx) composed mainly of CRF01_AE with inserts from subtypes B and C identified from three epidemiologically unlinked individuals in Yunnan province, China. Two of the subjects are heterosexual men and one is a male intravenous drug user. Sequencing and analyzing the near-full-length genome of these three isolates (YNTC88, YNTC19, and YNTC35) revealed identical recombination breakpoints in all three viruses, but considerable genetic diversity between them, across the genomes, indicating that this is not a newly created CRF, only newly detected. CRF78_cpx differs from previously documented CRF01-AE/B'/C forms in its distinct backbone, inserted fragment size, and breakpoints, and is not related to other described recombinants in the region such as CRF07_BC or CRF65_cpx (also composed of CRF01_AE, B', and C). Our present findings further enrich the diversity of the prevalent HIV-1 CRFs in Yunnan, which is considered as an epicenter of HIV-1 infections in China.

IFNL4 rs368234815 polymorphism is associated with innate resistance to HIV-1 infection.

The interferon (IFN)L4 polymorphism rs368234815 is associated with hepatitis C virus (HCV) spontaneous clearance and response to IFN-based treatments. The role of this polymorphism in HIV-1 infection is controversial. We investigated whether genetic variation at IFNL4 is associated to HIV-1 acquisition. The HCV protective allele TT was associated with decreased likelihood of HIV-1 infection in male intravenous drug users [odds ratio (OR): 0.3; P = 0.006], and this association was not modified by the genotype of CCR5. These results suggest that genetic susceptibility to HCV and HIV-1 infection shares common molecular pathways.

A SDF1 genetic variant confers resistance to HIV-1 infection in intravenous drug users in China

Despite repeated exposures to HIV-1, some individuals remain uninfected, suggesting that genetic factors confer host resistance to HIV-1 acquisition. The chemokine receptors CCR5, CXCR4 and the principal ligand SDF1 of CXCR4 play an important role for the entry of HIV-1 to target cells. To explore the relationship between genetic variants and HIV-1 infection, 11 common SNPs in CCR5, CXCR4 and SDF1 were genotyped in 921 male intravenous drug users (IDUs), of which 263 individuals were HIV-1-exposed seropositive (HESP) and 658 were HIV-1-exposed seronegative (HESN). According to the situation of syringe-sharing, the whole cohort was divided into two subgroups: syringe-sharing (SS) and syringe-not-sharing (SNS). We found that in the SNS subgroup rs17540465 of SDF1 showed significant difference of allele and genotype frequencies between HESP IDUs and HESN IDUs, but not in the SS subgroup. HESP with SNS carried significantly less allele A compared with HESN with SNS, indicating a protective role of allele A against HIV-1 infection. Syringe-sharing IDUs are supposed to be exposed highly to HIV-1 infection risk due to the direct transfer of HIV-1 infected blood to another. For syringe-not-sharing IDUs, sexual contact may be the major route of HIV-1 transmission. Considering the different route of HIV-1 transfection between two subgroups, we speculate that SDF1 may contribute susceptibility to HIV-1 infection in the route of sexual intercourse.

5 Year Follow-up of a Tricuspid Valve Replacement Resulting from Infective Endocarditis Complicated by Multiple Pulmonary Abscesses

A 30-year-old male intravenous drug user underwent a tricuspid valve replacement with a mechanical ATS Open Pivot® bileaflet prosthesis due to Staphylococcus aureus infective endocarditis. Preceding investigations also revealed concomitant bilateral pulmonary abscesses which were successfully treated with broad-spectrum antimicrobials. Follow-up at 5 years demonstrated a well functioning valve prosthesis with a low gradient. This case emphasises the importance of a multidisciplinary approach in the successful treatment of infective endocarditis.

Risk Factors and Outcomes for Late Presentation for HIV-Positive Persons in Europe: Results from the Collaboration of Observational HIV Epidemiological Research Europe Study (COHERE)

Few studies have monitored late presentation (LP) of HIV infection over the European continent, including Eastern Europe. Study objectives were to explore the impact of LP on AIDS and mortality. LP was defined in Collaboration of Observational HIV Epidemiological Research Europe (COHERE) as HIV diagnosis with a CD4 count <350/mm(3) or an AIDS diagnosis within 6 months of HIV diagnosis among persons presenting for care between 1 January 2000 and 30 June 2011. Logistic regression was used to identify factors associated with LP and Poisson regression to explore the impact on AIDS/death. 84,524 individuals from 23 cohorts in 35 countries contributed data; 45,488 were LP (53.8%). LP was highest in heterosexual males (66.1%), Southern European countries (57.0%), and persons originating from Africa (65.1%). LP decreased from 57.3% in 2000 to 51.7% in 2010/2011 (adjusted odds ratio [aOR] 0.96; 95% CI 0.95-0.97). LP decreased over time in both Central and Northern Europe among homosexual men, and male and female heterosexuals, but increased over time for female heterosexuals and male intravenous drug users (IDUs) from Southern Europe and in male and female IDUs from Eastern Europe. 8,187 AIDS/deaths occurred during 327,003 person-years of follow-up. In the first year after HIV diagnosis, LP was associated with over a 13-fold increased incidence of AIDS/death in Southern Europe (adjusted incidence rate ratio [aIRR] 13.02; 95% CI 8.19-20.70) and over a 6-fold increased rate in Eastern Europe (aIRR 6.64; 95% CI 3.55-12.43). LP has decreased over time across Europe, but remains a significant issue in the region in all HIV exposure groups. LP increased in male IDUs and female heterosexuals from Southern Europe and IDUs in Eastern Europe. LP was associated with an increased rate of AIDS/deaths, particularly in the first year after HIV diagnosis, with significant variation across Europe. Earlier and more widespread testing, timely referrals after testing positive, and improved retention in care strategies are required to further reduce the incidence of LP.

Inability to detect human T cell lymphotropic virus type 2-specific antibodies in a patient coinfected with HIV-1, human T cell lymphotropic virus type 1, human T cell lymphotropic virus type 2, and hepatitis C virus.

HIV-1, human T cell lymphotropic virus type 1 and type 2 (HTLV-1 and HTLV-2) and hepatitis C virus (HCV) are common among intravenous drug users (IDUs) and can cause chronic infections in the host. Usually, the diagnosis of such viruses employs serological assays; however, some difficulties in confirming HTLV-2 infection have been reported in high-risk populations in Brazil. We present data of an unusual case of coinfection with HIV-1, HTLV-1, HTLV-2, and HCV in a male IDU in which HTLV-2 was detected only by molecular assays. Comparative analysis of retroviruses from 2002 and 2012 showed identical HTLV-1 and HTLV-2 sequences (LTR, env, and tax), and a change in HIV-1 tropism from CXCR4 to CCR5. No mutation was detected in the hot points of the env region of the HTLV-2 isolate that justified the lack of rgp46-II-specific antibodies. These data emphasize the need for molecular assays to diagnose HTLV-2 in high-risk populations in Brazil.

Unprotected anal Intercourse among Iranian Intra-Venous Drug Users

Purpose: To assess the prevalence and associated factors of unprotected anal intercourse among Iranian male heterosexual Intra-Venous Drug Users (IDUs).Methods: In a cross-sectional study 360 male heterosexual IDUs were sampled from streets of eight different geographical parts of Iran. Variables such as socio-demographics, HIV knowledge (10 items), and HIV attitude (16 items) were entered to a logistic regression to determine the predictors of unprotected anal intercourse during the past month.Results: From all, 20.8% reported unprotected anal intercourse during the past month. HIV knowledge was not significantly different among IDUs with and without unprotected anal intercourse. High age [odds ratio (OR) = 0.954, 95% confidence intervals (CI) = 0.916–0.992] was associated with a lower likelihood of unprotected anal intercourse, while being not married (OR = 2.301, 95% CI = 1.151–4.601), and high perceived HIV risk (OR = 1.776, 95% CI = 1.376–2.290) were associated with a higher likelihood of unprotected anal intercourse.Conclusion: Although the results might not be generalizable to all Iranian IDUs, this study findings may still be helpful for design and implementation of public health programs in Iran to prevent sexual transmission of HIV through IDUs.

P1-S5.27 Low prevalence of asymptomatic STI in HIV-infected heterosexual males and females, visiting an HIV outpatient clinic in the Netherlands

Background In the Netherlands no guidelines exist for routine STI screening of HIV-infected patients. In a study in two academic hospitals in the Netherlands, 16% of HIV-infected MSM in HIV care had an asymptomatic STI, making regular STI screening in this group appropriate. It is unclear whether regular STI screening should also be considered for HIV-infected heterosexual men and women. Therefore, we studied the prevalence of, and factors associated with asymptomatic STI in a representative group of HIV positive heterosexual men and women. Methods HIV-1 infected heterosexual patients visiting the HIV outpatient clinic of the Academic Medical Center in Amsterdam, the Netherlands, were screened for STI during a routine visit. Patients spontaneously reporting symptoms compatible with STI were excluded. Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) were tested by PCR on throat swabs, vaginal or anal self swabs and urine samples, depending on gender and sexual behaviour. Hepatitis B virus (HBV) and hepatitis C virus (HCV) serology were performed and patients were screened for syphilis by TPHA and RPR. Participants were interviewed by a trained interviewer about sexual risk behaviour in the previous 6 months. Results Between October 2007 and June 2008, 248 men and women (median age 41 years, range 18–82) were included. 56% was female and 42% had Dutch ethnicity, the main other ethnicities were Ghanese, Surinamese/Antillean and Sub-Saharan African. The Abstract P1-S5.27 table 1 shows sexual behaviour of participants in the preceding 6 months. Reported history of STI in the last 6 months was 2%, and lifetime history of STI (non-HIV) was 49%. 29% of participants had had STI testing in the preceding 6 months, and 64% had an STI test more than 6 months ago. Only four patients (1.6%) had an asymptomatic STI. Two women were diagnosed with vaginal CT, 1 man with urethral CT and a female intravenous drug user with a history of syphilis had a new syphilis infection. We also identified one hitherto undiagnosed HCV infection; this was in a male intravenous drug user without a history of sex with men; we did not classify this as an STI. Conclusions In this population of HIV-1 infected heterosexual patients in care for HIV infection high risk sexual behaviour is rare and asymptomatic STI are uncommon. Our study results suggest that routine screening in asymptomatic heterosexual patients is currently not needed.

Clinical outcome of acute and chronic hepatitis delta over time: a long-term follow-up study

Long-term changes in the frequency and outcome of hepatitis delta virus (HDV) infection have seldom been analysed. This retrospective, longitudinal study includes 398 consecutive hepatitis B surface antigen (HBsAg)-positive patients with anti-HDV antibodies who attended our institution between 1983 and 2008. At enrolment, 182 patients had acute and 216 chronic hepatitis. Patients were grouped into two periods. Those who attended between 1983 and 1995 and those between 1996 and 2008. The former group was significantly younger, mainly intravenous drugs users, and had a greater incidence of acute HDV and HIV and HCV coinfection. Patients with acute HBV/HDV coinfection cleared both infections in 90% of cases, while all patients with HDV superinfection evolved to chronic disease. One hundred and fifty-eight patients with chronic HDV were followed for a median period of 158months. Seventy-two per cent of the patients remained stable, 18% had hepatic decompensation, 3% developed hepatocellular carcinoma, and 8% cleared HBsAg. Liver-related death was observed in 13% of patients and mainly occurred in patients from the first period (P=0.012). These results indicate an outbreak of HDV at the end of the 1980s and the beginning of the 1990s, with a large number of acute HDV cases affecting predominately young, male intravenous drug users. Currently, patients with chronic HDV disease are older, and factors associated with worse prognosis include the presence of cirrhosis and age at the time of diagnosis.

Methicillin-resistant Staphylococcus aureus retropharyngeal abscess complicated by a cervical spinal subdural empyema

Methicillin-resistant Staphylococcus aureus (MRSA) cervical spinal subdural empyema as a result of a retropharyngeal abscess has not been reported previously. We present a 65-year-old male intravenous drug user who developed spinal subdural empyema after an operation for a retropharyngeal abscess. Although imaging diagnosis and follow-up surgery were performed quickly, the neurological outcome was poor. We review the literature on retropharyngeal abscess with intraspinal infection.