Number Of Intravenous Drug Users Research Articles

Infections in Intravenous Drug Users in the Perspective of Infectious Emergencies

Introduction; An increasing number of intravenous drug users are seen in now days. Intravenous drug users (IDUs) are a group of subjects who inject different drugs, generally in the extremities. This way of taking drugs, apart from leading to an addiction, on the other hand also serves as the possibility of taking or spreading infections.
 The aim of this paper is to provide a brief overview of IDUs patients, who were presented to the emergency department of the infectious diseases service, and required further hospitalization, during the period January 2012 - December 2015.
 Material and methods: The study is retrospective and was carried out in the emergency department of the infectious disease service and the infectious disease service as well. During the period January 2012 – December 2015, 26 patients were hospitalized in our hospital as IDUs. There were 20 male patients. The average age of the patients was 32 years. The main clinical symptoms were fever, dyspnea, chest pain, pain in the extremities, edema of the extremities, necrotic ulcers at the injection site, jaundice in the sclera, confusional state. The resulting diagnoses were viral infections (HIV/AIDS infection, viral hepatitis), septic conditions (endocarditis, fasciitis), skin infections (cellulitis, S. aureus infections), pulmonary infections.
 Conclusions: Viral, bacterial and fungal infectious diseases are quite frequent among the people of this community. This is related to the way of life (poor social economic conditions, poor hygiene), risky sexual behaviors and the use of syringes from one person to another. The screening of this community is important to prevent any infectious disease.

Molecular Epidemiology and Baseline Resistance of Hepatitis C Virus to Direct Acting Antivirals in Croatia.

Molecular epidemiology of hepatitis C virus (HCV) is exceptionally complex due to the highly diverse HCV genome. Genetic diversity, transmission dynamics, and epidemic history of the most common HCV genotypes were inferred by population sequencing of the HCV NS3, NS5A, and NS5B region followed by phylogenetic and phylodynamic analysis. The results of this research suggest high overall prevalence of baseline NS3 resistance associate substitutions (RAS) (33.0%), moderate prevalence of NS5A RAS (13.7%), and low prevalence of nucleoside inhibitor NS5B RAS (8.3%). Prevalence of RAS significantly differed according to HCV genotype, with the highest prevalence of baseline resistance to NS3 inhibitors and NS5A inhibitors observed in HCV subtype 1a (68.8%) and subtype 1b (21.3%), respectively. Phylogenetic tree reconstructions showed two distinct clades within the subtype 1a, clade I (62.4%) and clade II (37.6%). NS3 RAS were preferentially associated with clade I. Phylogenetic analysis demonstrated that 27 (9.0%) HCV sequences had a presumed epidemiological link with another sequence and classified into 13 transmission pairs or clusters which were predominantly comprised of subtype 3a viruses and commonly detected among intravenous drug users (IDU). Phylodynamic analyses highlighted an exponential increase in subtype 1a and 3a effective population size in the late 20th century, which is a period associated with an explosive increase in the number of IDU in Croatia.

Infective endocarditis and outcomes of valve surgery: the bug, the valve, the host and the unknown

Infective endocarditis (IE) is becoming growing national epidemic in the US (1). The etiology of this substantial increase in IE prevalence is multifactorial, but is likely due to the increasing number of intravenous drug users, patients with prosthetic valves and/or implantable devices, immune-compromised patients, and patients with chronic indwelling catheters (2).

Infective endocarditis in Western Norway: a 20-year retrospective survey

Background: To investigate epidemiological trends of infective endocarditis (IE) in western Norway a retrospective study was performed.Methods: Characteristics of 706 IE admissions from 1996 to 2005 and 2006 to 2015 were analysed and compared using the Chi-square test for categorical variables and the t-test for age. Survival was analysed by multiple Cox regression and reported by the hazard ratio (HR).Results: Mean annual incidence rates increased from 4.6 to 7.4 per 100,000 inhabitants (rate ratio: 1.97, 95% confidence interval: 1.52–2.56, p < .001). Non-viridans streptococci, enterococci and Staphylococcus aureus (S. aureus), were all independently associated with increased mortality. The frequency of IE caused by enterococci increased from 3.7 to 13.0% (p < .001). The proportion of intravenous drug users (IVDU) increased from 16.5 to 23.5% (p = .015) and had increasing aortic valve involvement (p = .023). Prosthetic valve endocarditis (PVE) constituted 30% of IE cases in both decades with biological PVE increasing from 9.4 to 22.1% (p < .001) and mechanical PVE decreasing from 18.7 to 8.9% (p < .001). In the last decade, valve replacement surgery was performed in 37.6% of the patients, of which 85.5% received a bioprosthesis.Conclusions: The incidence of IE increased significantly. Non-viridans streptococci, enterococci and S. aureus were all significantly associated with increased mortality. The increased number of enterococcal IE and the increased number of IVDUs with left-sided IE constituted new challenges. Biological implants were preferred in a majority of patients requiring surgery.

Right-Sided Infective Endocarditis and Pulmonary Infiltrates: An Update.

Sixty years after its initial description, right-sided infective endocarditis (RSIE) still poses a challenge to all medical practitioners. Epidemiological data reveal a rising incidence attributable to the global surge in the number of intravenous drug users and the increased use of central vascular catheters and implantable cardiac devices. RSIE differs from left-sided infective endocarditis in more than just the location of the involved cardiac valve. They have different clinical presentations, diagnostic findings, and prognoses; hence, they require different management strategies. Cardiac murmurs and systemic emboli are usually absent in RSIE, whereas pulmonary embolism and its related complications dominate the clinical picture. Diagnostic delay of RSIE is secondary to the similarity in its initial presentation to other entities. Complications may ensue as a result of this delay. Diagnosis can be initially confirmed by using transthoracic echocardiography, except in patients with implanted cardioverter defibrillator, where a transesophageal echocardiogram is necessary. Various factors may increase mortality and morbidity in RSIE such as tricuspid valve vegetation size, fungal etiology, and low CD4 cell count in HIV patients. Oxacillin and vancomycin had been the traditionally used agents for the treatment of methicillin-susceptible and methicillin-resistant Staphylococcus aureus, respectively. More recently, daptomycin has shown promising results, which has led to its Food and Drug Administration (FDA) approval for the treatment of S. aureus bacteremia and associated RSIE. The aim of this article is to provide a comprehensive update on RSIE including epidemiology, pathogenesis, microbiology, diagnosis, management, and prognosis.

Surgical outcomes of infective endocarditis among intravenous drug users

BackgroundWith increasing prevalence of injected drug use in the United States, a growing number of intravenous drug users (IVDUs) are at risk for infective endocarditis (IE) that may require surgical intervention; however, few data exist about clinical outcomes of these individuals. MethodsWe evaluated consecutive adult patients undergoing surgery for active IE between 2002 and 2014 pooled from 2 prospective institutional databases. Death and valve-related events, including reinfection or heart valve reoperation, thromboembolism, and anticoagulation-related hemorrhage were evaluated. ResultsOf the 436 patients identified, 78 (17.9%) were current IVDUs. The proportion of IVDUs increased from 14.8% in 2002 to 2004 to 26.1% in 2012 to 2014. IVDUs were younger (aged 35.9 ± 9.9 years vs 59.3 ± 14.1 years) and had fewer cardiovascular risk factors than non-IVDUs. During follow-up (median, 29.4 months; quartile 1-3, 4.7-72.6 months), adverse events among all patients included death in 92, reinfection in 42, valve-reoperation in 35, thromboembolism in 17, and hemorrhage in 16. Operative mortality was lower among IVDUs (odds ratio, 0.25; 95% confidence interval [CI], 0.06-0.71), but overall mortality was not significantly different (hazard ratio [HR], 0.78; 95% CI, 0.44-1.37). When baseline profiles were adjusted by propensity score, IVDUs had higher risk of valve-related complications (HR, 3.82; 95% CI, 1.95-7.49; P < .001) principally attributable to higher rates of reinfection (HR, 6.20; 95% CI, 2.56-15.00; P < .001). ConclusionsThe proportion of IVDUs among surgically treated IE patients is increasing. Although IVDUs have lower operative risk, long-term outcomes are compromised by reinfection.

Postpartum evolution of newborns to mothers addicted to “new drugs” and recently diagnosed with HIV infection

Background In 2011 and 2012 Romania registered a significant increase in the number of intravenous drug users (IVDUs) along with a change in the use pattern, namely the replacement of heroin with the so called “new drugs”. These are mostly synthetic cannabinoids and cathiones. Within this context, the share of new IVDU-HIV cases expanded from 3% in 2010 to 29% in 2012. Our objective was to observe the evolution of 30 newborns to mothers recently diagnosed with HIV infection, who were also “new drugs” consumers.

Traitements de substitution aux opiacés : état des lieux du point de vue du médecin

Widespread diffusion of opiate substitution therapy (OST), particularly with high-dose buprenorphine (BHD) has led to a considerable decline in the number of intravenous drug users (IVDU) in France, in parallel with a reduction in the volume of over-the-counter syringe sales, the number of overdoses, the use of heroin, and the associated delinquency, and HIV prevalence. OST also plays a crucial role in improving observance of anti-HIV, and anti-HCV treatments as well as an improvement in the quality-of-life of IVDUs. But fraudulent behavior (resellers, dealers), and misuse (sniff, inhalation, injection for BHD, fractionated or excessive doses, association with other psychoactive products for BHD and methadone) have also developed. Misuse is related either to the difficult, and progressive adhesion process during the early phases of OST or to a situation of therapeutic failure after long-term appropriate OST. Unless access to care is facilitated with new therapeutic options capable of matching the benefits of OST, healthcare professionals will have little to offer in the event of therapeutic failure.

Hepatitis C in India

Hepatitis C is an emerging infection in India and an important pathogen causing liver disease in India.The high risk of chronicity of this blood-borne infection and its association with hepatocellular carcinoma underscores its public health importance. Blood transfusion and unsafe therapeutic interventions by infected needles are two preventable modalities of spread of hepatitis C infection. In addition, risk factor modification by reducing the number of intravenous drug users will help curtail the prevalence of this infection. This review summarizes the extent, nature and implications of this relatively new pathogen in causing disease in India.

Clinical wastes in the community: local authority management of discarded drug litter

Despite comprehensive multi-agency management of complex social, criminal and health issues surrounding illicit drug use, substance abuse continues to escalate. Previously limited to deprived inner city areas, most communities now record rising numbers of intravenous drug users (IDUs) with increases of drug litter carelessly discarded in the environment, particularly in parks, gardens and public toilets. Bloodborne virus transmission with Hepatitis B (HBV) and Hepatitis C virus (HCV), and Human Immunodeficiency Virus (HIV) is the primary hazard. Needlestick injuries continue to occur, often involving children. Seroconversion and life-threatening infection is uncommon, although post-exposure prophylaxis and extensive follow-up is necessary and this may precipitate prolonged and debilitating stress for the victim and family group. Local authorities must maintain strategies to ensure the prompt and safe retrieval of drug litter. To evaluate the effectiveness of these services, an audit was undertaken to review information on the websites of each county, borough and district council and unitary authority throughout England (n 1⁄4 439), Northern Ireland (n 1⁄4 29), Scotland (n 1⁄4 37) and Wales (n 1⁄4 21). These 526 sites were accessed using search strategies described pre-

Epidemiological aspects of hepatitis C virus infection among HIV-infected individuals in Mato Grosso State, Central Brazil

The present study has been carried out to estimate the prevalence of HCV among HIV-positive individuals in the state of Mato Grosso, Central Brazil, as well as to identify the associated epidemiological factors. One thousand and eight individuals over 18 years of age bearing HIV/aids and being attended in the reference public health network of the state of Mato Grosso participated in this research. HIV-positive subjects were interviewed and blood samples were taken to be tested for anti-HCV antibodies by enzyme immunoassay (EIA). The anti-HCV antibodies were investigated in all the individuals by immunoenzymatic assay. The reactive samples in duplicate were submitted to a polymerase chain reaction (PCR) to detect HCV-RNA. The positive tests were submitted for genotyping by the LIA method. One hundred and ten (10.9%; CI 95%: 9.1–13.0) HIV-positive individuals presented anti-HCV by EIA. The PCR was positive in 60 (6.0%; CI 95%: 4.6–7.6) individuals. The 1a genotype was the most frequent, followed by the 3a and 1b. The genotype 2 was found in only one individual. There were more male and intravenous drug users among HIV–HCV coinfected individuals when compared to only HIV-infected individuals. Multivariate analysis revealed an association between the HIV–HCV coinfection, regarding either EIA or PCR results, and the use of intravenous drugs, the presence of tattoos, and having received blood transfusions before 1994. There was no association of the coinfection with the variables related to sexual transmission. The relatively low prevalence of HCV infection in the HIV-positive population in that region may be a consequence of a small number of intravenous drug users in the sample, despite a strong association between HCV infection and use of intravenous drugs.

Verlauf der HIV-Epidemie in Deutschland

The course of the HIV epidemic in Germany can be modelled by back calculation until the beginning of the nineties. The recent course of the epidemic can only be derived from surveillance data of newly diagnosed HIV infections in conjunction with other data sources. Based on these surveillance data HIV incidence in Germany can be estimated to have been stable with 2000 to 2500 new infections per year since the early nineties, after having peaked in the early eighties. The most affected group are men who have sex with men followed by persons infected by heterosexual contact and migrants from high prevalence countries. The number of intravenous drug users has declined over the years and is now in fourth place. There are indications that increased risk behaviour and rising numbers of other sexually transmitted infections together with a change towards later initiation of antiretroviral therapy has led to an increase in new HIV infections in Germany in recent years. An improvement of the epidemiological surveillance for "indicator" STIs in combination with the assessment of risk behaviours in high risk groups would be desirable steps towards a second generation surveillance in Germany.

Estudio retrospectivo de la endocarditis infecciosa en diferentes grupos de riesgo

Due to the increasing number of intravenous drug users, subjects with immune deficiencies or with prosthetic valves, infective endocarditis (IE) continues to be prevalent and to have a high mortality. To review all cases of infective endocarditis diagnosed in an Internal Medicine Service. Retrospective review of medical records of all patients with infective endocarditis, hospitalized in an Internal Medicine ward, between 1989 and 2003. Dukes criteria were used to define definitive, possible and less probable cases of IE. Eighty seven patients with definite IE were identified (66 males, age range 19-84 years), with a mean incidence of 5.3 per 1000 hospitalizations. IE in intravenous drugs users was usually caused by Staphylococcus aureus and presented high risk of embolism (RR: 3,21). Subjects aged over 70 years had a relative risk of mortality of 5.5. Hospital acquired IE was associated with advanced age and IV catheters appeared as the only predisposing factor. Patients with prosthetic valves were also older, their main complication was abscess formation and their mortality was higher. A closer approach to differential conditions of patients, according to age, intravenous drug use or the presence of prosthetic valves, is necessary.

Harm Reduction Program and Methadone Poisoning: Implications for Pediatric Public Health in Malaysia

In Malaysia, because of an alarming increase in the number of intravenous drug users, the government has started a harm reduction program in which methadone is used as a drug substitution therapy. This article discusses a 19-month-old Malay girl who was brought to the hospital after an episode of accidental ingestion of methadone. The methadone was for her uncle, who was found to be an intravenous drug user. Although methadone has been proven to be cost-effective and useful, it has also been reported that increasing availability of methadone can put children at increased risk of accidental ingestion. In Malaysia, methadone is available at government as well as private medical clinics. Home consumption may be problematic as the drug may be dispensed without adequate patient education and clear instructions on its handling, storage, and indication of use. In this scenario, a greater emphasis on and the adaptation of clear guidelines on the use and storage of methadone are required. There is also a need to create awareness among the public as well as health care professionals regarding the issue.

Prevention and health promotion in school and community settings: a commentary on the international perspective

Although somehow different in scale and scope the main public health problems adolescents currently face around the world are quite similar in nature. Therefore international comparisons in the field of health and preventive interventions are quite important. This article outlines some basic concepts used in the international field of adolescent health prevention and promotion with emphases on youth participation process evaluation and analyses of trends of behavior as means to assess both the impact of preventive activities and the influence of the norms and values of the surrounding society. Using examples in the areas of school health substance use and adolescent sexuality this article highlights the usefulness of research and intervention approaches that go beyond the traditional quantitative measures of efficiency and effectiveness. (excerpt)

Hepatitis C virus molecular epidemiology in Uzbekistan.

The aim of this study was to identify hepatitis C virus (HCV) genotypes and to estimate their prevalence in various risk groups and the regional distribution in Uzbekistan. Preliminary serological screening of 1,269 subjects revealed 6.5% anti-HCV-positive in a general population, 27.1% in patient groups, and 51.7% among intravenous drug users. HCV genotypes of 104 anti-HCV-positive subjects were determined using a PCR-genotyping system in core region, and the results were supported by nucleotide sequencing of the NS5B region. Genotype 1b identified in total 64.2%, was the most prevalent. The genotype 3a identified in 25.0% was the second one distributed. HCV genotypes 2a, 1a, 2b, and 3b were identified in 3.8%, 2.9%, 2.9%, and 1.0% of cases, respectively. The intravenous drug users were distinguished from other groups by having the highest prevalence of genotype 3a, i.e., 50.0%, higher than the 33.3% for genotype 1b in this group. Geographically, genotype 1b was common; genotype 3a was also found frequently in all three regions. Uncommon HCV genotypes (1a, 2a, 2b, and 3b) were found in comparatively greater variability in the western region. Molecular evolutionary analysis based on the NS5B region did not reveal specific clustering or indigenous strains among Uzbekistan HCV isolates. In summary, two main mechanisms of HCV infection distribution were observed in Uzbekistan: HCV 1b genotype infection is widespread through blood products, and HCV 3a genotype infection is spreading through the growing number of intravenous drug users.

Recent evolution in opiate dependence in France during generalisation of maintenance treatments

Two maintenance drugs had been used in France since 1996, methadone and high-dosage buprenorphine. This study aimed to examine changes in drug use from observations gathered between 1995 and 1997, within the framework of the French program for the monitoring of drug dependence (OPPIDUM). This annual survey studies psychoactive substances consumed by drug addicts attending specialised drug care centres. During the last three surveys, 16 centres collected a total of 1597 patient-files. This study shows an increase in the number of patients undergoing maintenance treatment (from 14 to 69%), a reduction in the number of intravenous drug users (from 55 to 22%) and a reduction in consumption of psychoactive substances. However, poly-drug addiction behaviour continues and high-dose buprenorphine subjects frequently use the substance intravenously and in association with benzodiazepines.

Empirical Bayes approach to estimating the number of HIV‐infected individuals in hidden and elusive populations

In this paper we estimate the numbers of intravenous drug users (IVDUs) and commercial sex workers (CSWs) in Thailand infected with human immunodeficiency virus (HIV) who have not developed acquired immunodeficiency syndrome (AIDS) directly from the semi-annual HIV serosurveillance data of Thailand from June 1993 to June 1995. We propose a ‘generalized removal model for open populations’ for estimating HIV-infected population size within a hidden, elusive, and perhaps high-risk population group, for all sampling time when capture probabilities vary with time. We apply empirical Bayes methodology to the generalized removal model for open populations by using the Gibbs sampler, a Markov chain Monte Carlo method. No assumption on the size of the hidden population in question is needed to implement this procedure. The statistical method proposed here requires very little computing and only a minimum of two sets of serosurvey data to obtain an estimate, thereby providing a simple and viable option in epidemiological studies when either powerful computing facilities or abundant sampling data are lacking. Copyright © 2000 John Wiley & Sons, Ltd.

Feasibility in needle exchange programme: an evaluation of a pilot programme in Catania, Sicily

Introduction: Intravenous drug use (10 V) is a primary transmission route for HIV and other blood borne disease. A criminal approach to illicit drug use leads to aggressive attitudes towards drug users and forces them underground, thus hindering their access to Health Service outlets. A 6-month pilot Needle Exchange Programme was set up in Catania, with the aim of reducing the negative effects and consequences of drug use, preventing the spread of blood borne diseases by encouraging the use of clean needles and reduction of needle sharing. To establish contact with the hidden population of the city’s, intravenous drug users (IDUs) and promote condom use and safer sex. Method: An equipped camper was parked daily in two of the city’s main public squares according to a preset timetable, morning and afternoon. A flexible needle exchange policy, i.e. free clean needles given out regardless of those returned, was adopted as a strategy considered necessary in order to, ensure maximum user-friendliness. Safer shooting information leaflets were given out alongside material for the correct use of the condom and condoms. Result: The number of IDUs, contacted who had previously been referred to a National Health Service Drug Unit (Ser.T.) and not, and number of syringes exchanged were low but increased month by month. Conclusion: Future projects should be undertaken after building up, a collaborative network between Street Unit and local courts; the city police force; social service outlets; hospitals and other health outlets; Ser.T. units and local pharmacies. In the light of our current experience, the one to one strategy instead to the flexible strategy could lead to stricter adherence to harm reduction strategies amongst IDUs.

Empirical Bayes approach to estimating the number of HIV-infected individuals in hidden and elusive populations.

In this paper we estimate the numbers of intravenous drug users (IVDUs) and commercial sex workers (CSWs) in Thailand infected with human immunodeficiency virus (HIV) who have not developed acquired immunodeficiency syndrome (AIDS) directly from the semi-annual HIV serosurveillance data of Thailand from June 1993 to June 1995. We propose a 'generalized removal model for open populations' for estimating HIV-infected population size within a hidden, elusive, and perhaps high-risk population group, for all sampling time when capture probabilities vary with time. We apply empirical Bayes methodology to the generalized removal model for open populations by using the Gibbs sampler, a Markov chain Monte Carlo method. No assumption on the size of the hidden population in question is needed to implement this procedure. The statistical method proposed here requires very little computing and only a minimum of two sets of serosurvey data to obtain an estimate, thereby providing a simple and viable option in epidemiological studies when either powerful computing facilities or abundant sampling data are lacking.