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PubMed2001

Clostridium novyi infection: a fatal association with injecting drug users.

Injecting drug users frequently use accident and emergency (A&E) departments to access emergency care for local and systemic infections. Clostridium novyi type A is a bacterium that has recently been associated with a number of fatalities among drug injecting addicts. The clinical course is described of a patient who attended an A&E department with septicaemia who was found at postmortem examination to have been infected with Clostridium novyi type A. Doctors working in A&E departments should be aware of the existence of this infection and be vigilant when treating injecting drug users with localised infection.

Clostridium↗
PubMed1999

Mycotic aneurysm presenting as Pancoast's syndrome in an injection drug user.

Injection drug users frequently present to emergency departments with fever. A careful history and physical examination with attention to anatomic localization of symptoms and signs are often necessary to unmask unusual underlying medical conditions. We report a case of a woman with recent injection drug use who presented with fever, a palpable neck mass, and Pancoast's syndrome. She had been seen recently at the ED of another hospital and discharged with oral antibiotics for presumed cellulitis. A mycotic aneurysm of the subclavian artery causing Pancoast's syndrome was later diagnosed by using computed tomography and angiography. A high index of suspicion for anatomically localized infective processes should always be maintained with febrile injection drug users.

Adult↗
PubMed1996

Endocarditis in injection drug users.

Injection drug use is an important risk factor for endocarditis. The clinical manifestations of endocarditis associated with injection drug use differ from those in person who do not use drugs. Endocarditis in drug users more often affects the right side of the heart and presents with fever and pulmonary emboli rather than left-sided emboli. Blood cultures and echocardiography are the mainstay of diagnosis; these tests are particularly helpful in identification of endocarditis associated with injection drug use because of the high frequency of right-sided valvular involvement and the low incidence of culture-negative endocarditis in this population. Since staphylococcal species are the dominant causative organism, penicillin and an aminoglycoside are the treatments of choice. Injection drug users with left-sided endocarditis or with symptomatic human immunodeficiency virus infection have poor prognoses.

Anti-Bacterial Agents↗
PubMed2005

Co-infection by human immuno deficiency virus, hepatitis B and hepatitis C virus in injecting drug users.

Injecting drug users (IDUs) are at risk of parenterally transmitted diseases such as hepatitis B virus (HBV) hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infections. The present study was undertaken to find out the prevalence of HIV infection, HBV infection and HCV infection among IDUs of a deaddiction centre. Serum samples from 250, injecting drug users (IDUs) from a de-addiction centre were screened for HBsAg using immunochromatography, anti HCV antibody by 3rd generation ELISA test and anti HIV antibody by ELISA test and immunochromatographic rapid test during the period August to October 2002. One hundred and forty-nine (59.6%) IDUs were positive for HIV antibody, 226 (90.4%) were positive for anti HCV antibody and 27 (10.8%) were positive for HBsAg. There was co-infection of HIV, HBV and HCV in 15 (6%) of the IDUs. The Co-infection of HBV and HCV were found in 12 cases (4.8%) and Co-infection of HIV and HCV was found in 131 cases (52.4%). The IDUs were in sexually active age group with a risk of infection to their sexual partner. There is high prevalence of HCV and HIV infection and co-infection of both viruses among IDUs. Comprehensive public health interventions targeting this population and their sexual partners must be encouraged. Increase coverage of needle, syringe exchange programme (NSEP) to young and new IDUs is required before they are exposed to blood borne viruses.

Adolescent↗
PubMed2002

High prevalence of hepatitis E antibodies among Danish prisoners and drug users.

Injecting drug users and prisoners have high prevalences of antibodies to hepatitis A-C. The aim of this study was to determine the prevalence of antibodies to hepatitis E virus (anti-HEV) in two Danish high-risk populations and correlate anti-HEV with risk factors for transmission. Three hundred thirty male prisoners and 137 patients at a drug treatment center were tested for anti-HEV with an in-house enzyme-linked immunoassay (EIA) utilizing antigens derived from open reading frame 2 (ORF2). This was compared with a commercial test with antigens derived from ORF2 and ORF3 (Abbott HEV EIA). In addition the samples were tested for antibodies against hepatitis A-C viruses, human immunodeficiency virus (HIV) 1 and 2, human T lymphotropic virus (HTLV) I and II and herpes simplex virus type 2 (HSV2). The participants were interviewed about risk factors for transmission. The anti-HEV prevalence was 16.9% (95% CI 14-21) for the in-house assay compared to 4.1% (95% CI 2.5-6.3) with the commercial assay. The correlation between the two assays was low (87% overall agreement; kappa value 0.32). One sample was strongly anti-HEV IgM positive, suggesting recent HEV infection inside Denmark. The presence of anti-HEV was associated significantly with anti-HAV among prisoners and increased with age in both groups. In contrast, associations were not found with injecting drug use or sexual risk factors. With the commercial assay an increased prevalence of anti-HEV was found among participants who had spent more than 5 years outside Northern Europe. In conclusion, anti-HEV was highly prevalent among Danish prisoners and drug users but not related to risk factors for blood-borne or sexual transmission.

Adult↗
PubMed2004

Hepatitis C virus infection in intravenous drug users.

Intravenous drug use (IVDU) remains a major means of hepatitis C virus (HCV) transmission. In this study, 101 drug users were studied prospectively after cessation of IVDU. Of these, 75.8% were anti-HCV positive, and 71.4% had elevated levels of alanine aminotransferase. These levels decreased significantly within 1 month of IVDU cessation (p 0.02). Liver biopsies showed minimal or mild fibrosis in 32 (71%) of 45 subjects, and severe fibrosis in two (4.4%) subjects. Anti-HCV-positive intravenous drug users in this study presented with mild liver disease and variable stages of disease progression. Biochemical disease activity might be affected by IVDU.

Adult↗
PubMed1984

[The personality structure of drug users].

34 drug users were examined with a questionnaire and Szondi's Projective Test. They were divided into three groups in order to permit statistical comparisons and interpretation of their drive structures as well as differential characteristics. The results of Szondi's Test reveal a profound imbalance in personality and in the possibility of object relationship, the latter showing differences between the sexes. Both groups react with numerous pathological symptoms, which are likely due to the consumption of drugs and to previous destructuring. The institutionalized drug users present conflicts which appear to be social rather than familial or psychological. For the other groups, difficulties of psychic structure and social integration appear to be due to family problems.

Adolescent↗
PubMed1996

Evidence for HIV type 1 strains of U.S. intravenous drug users as founders of AIDS epidemic among intravenous drug users in northern Europe.

To establish an epidemiological link between HIV-1 epidemics in U.S. and European homosexual men and intravenous drug users (IVDUs) we analyzed the HIV-1 gp120 V3 sequences in both risk groups. Signature pattern analysis revealed that the V3 sequences of viruses from IVDUs in Northern Europe are distinguishable from those of homosexual men on the basis of one amino acid and two synonymous nucleotide substitutions, which the most conserved was a synonymous nucleotide substitution in the second glycine codon at the tip of the gp120 V3 loop (GGC). This substitution was seen in 17 of 20 (85%) viruses of IVDUs in Northern Europe, in none of 41 homosexual men in either Europe or the United States, and in 5 of 11 (45%) U.S. IVDUs sequences analyzed. Subsequent phylogenetic and multivariate principal coordinate (PCOORD) analyses showed that 16 of 20 (80%) of the Northern European IVDU sequences clustered together with the 5 U.S. IVDU sequences carrying the GGC substitution and away from the sequences of homosexual men from either Europe or the United States. Taken together with the higher level of heterogeneity of U.S. IVDU sequences compared to the Dutch IVDU sequences taken at the same time, these data present suggestive evidence for a U.S. instead of a European origin of the AIDS epidemic among Northern European IVDUs.

Acquired Immunodeficiency Syndrome↗
PubMed1986

AIDS health education for intravenous drug users.

Intravenous (IV) drug users are the second largest risk group for AIDS and the main source of infection for heterosexual partner and pediatric AIDS cases. IV drug users have an addiction and a subculture that make risk reduction difficult; for example, to refuse to share needles can endanger personal relationships, and carrying clean works (rather than renting them in a shooting gallery) risks arrest. In New York City, at least, knowledge about AIDS transmission is widespread among IV drug users, and most drug injectors report having changed their drug use practices to reduce their risks. The main functions of health education in areas where IV drug users have this level of knowledge are to disseminate news of new discoveries; reach those drug users who have not yet learned AIDS basics; reinforce what is already known; and provide information about new programs to help drug users deal with AIDS-related problems. To encourage behavior change requires going beyond simple education, however; it entails trying to change IV drug user subculture. Drug user groups in the Netherlands and in New York City are attempting to do this from within the subculture. Outside intervention requires repeated messages from multiple sources; face-to-face, interactive communication; and perhaps the use of ex-addicts as health educators.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Clinical features, site of involvement, bacteriologic findings, and outcome of infective endocarditis in intravenous drug users.

BACKGROUND: Intravenous drug use is an increasingly common condition predisposing to infective endocarditis. Data on infective endocarditis in intravenous drug users are limited. OBJECTIVE: To determine the clinical features, bacteriologic findings, site of involvement, complications, and mortality associated with infective endocarditis in intravenous drug users. METHODS: Cohort study of intravenous drug users with native valve infective endocarditis. RESULTS: A total of 125 cases of infective endocarditis occurred in 114 patients (84 cases [67%] in men and 41 cases [32%] in women) with a mean (+/- SD) age of 37 +/- 7 years. The tricuspid valve was involved in 58 cases (46%), the mitral valve in 40 cases (32%), and the aortic valve in 24 cases (19%). The microorganisms identified included Staphylococcus in 82 cases (65.6%) and Streptococcus in 32 cases (25.6%). Twenty-three patients (18%) underwent surgery, and two (9%) of them died. One hundred two patients (82%) were treated medically, and nine (9%) of them died. Fifteen patients (63%) with aortic valve involvement vs 17 patients (17%) without aortic valve involvement underwent surgery or died without surgery (odds ratio, 8.24; 95% confidence interval, 3.1 to 21.8). Among the survivors, at least one major cardiovascular complication occurred in 79 cases (69.3%). CONCLUSIONS: Infective endocarditis in intravenous drug users affects the right and left sides of the heart with approximately equal frequency. At present, more than 90% of cases of infective endocarditis in intravenous drug users in Chicago are caused by staphylococci or streptococci. Involvement of the aortic valve is predictive of increased morbidity and mortality in intravenous drug users with infective endocarditis. With medical treatment, and surgery when medical treatment fails, intravenous drug users with infective endocarditis have an in-hospital survival rate of 91%.

Adult↗
PubMed1993

Factors associated with HIV seropositivity in European injecting drug users. The European Community Study Group on HIV in Injecting Drug Users.

OBJECTIVE: To study factors associated with HIV seropositivity among European injecting drug users (IDU). METHODS: Data on behavioural and other factors potentially associated with HIV status were collected retrospectively by personal interview with IDU (n = 2330) in a multicentre cross-sectional survey conducted in 12 European countries from 1989 to 1990. HIV status tested at the time of the survey was examined in relation to demographic data, history of imprisonment, travel to foreign countries, high-risk drug-using practices in the previous 6 months (re-using other IDU's injecting equipment without effective disinfection) and high-risk sexual behaviour in the last 6 months (multiple partners, unless none was IDU and condoms were always used). Analysis excluded IDU who claimed to be seropositive from previous testing. RESULTS: Imprisonment was significantly associated with current HIV status [odds ratio (OR), 1.70; 95% confidence interval (CI), 1.2-2.87]. High-risk drug-use practices were significantly associated with current HIV status in respondents not previously tested (OR, 2.86; 95% CI, 1.09-7.35) but not in respondents claiming to be seronegative. No significant association was found for high-risk sexual behaviour. CONCLUSIONS: Our experience supports the validity of retrospective investigation of behaviour in a population that is notoriously difficult to study. However, any interpretation of the apparently different associations of HIV status with high-risk sexual behaviour and high-risk drug-use practices must consider that factors tending to attenuate the correlations may operate differently in these two areas.

Adolescent↗
PubMed2005

HIV drug resistance and HIV transmission risk behaviors among active injection drug users.

HIV(+) injection drug users in clinical care may harbor and transmit drug-resistant HIV. We performed a retrospective study of HIV drug resistance and risk behavior among HIV(+) injection drug users in care to determine the number of needle-sharing events that involved and the proportion of sharing partners exposed to drug-resistant HIV. Among 180 HIV injection drug users, 55 (31%) reported injecting drugs in the previous month, and 22 of these (40%) shared needles and/or works 148 times with 296 partners, of whom 271 (92%) were thought to be HIV(-) or status unknown. Further, 55 (31%) drug users harbored resistant HIV, including 5 (3% of total) who also shared needles and/or works a total of 27 times with 44 partners (18% of all sharing events and 15% of all exposed partners). A small proportion of injection drug users receiving clinical care engage in injection risk behavior and carry resistant HIV; however, because of multiple partners and needle-sharing events, they expose a substantial number of individuals to drug-resistant HIV. Strategies to reduce injection drug use risk behaviors among patients in clinical care are needed to reduce the transmission of sensitive and resistant HIV.

Anti-HIV Agents↗
PubMed1993

Knowledge of HIV serostatus and preventive behaviour among European injecting drug users. The European Community Study Group on HIV in Injecting Drug Users.

OBJECTIVE: To study the effect of knowledge of HIV serostatus on behaviour for preventing the acquisition or transmission of HIV among European injecting drug users (IDU). METHODS: Data on behaviour and prior knowledge of HIV status were gathered during a multicentre cross-sectional survey of 200 European IDU recruited in 12 European countries in 1990. The respective proportions of IDU who (1) used condoms, (2) did not give their used injecting equipment to other IDU and (3) injected drugs safely (ether did not re-use other IDU's equipment or re-used it only after disinfection with bleach, alcohol or boiling water during the 6 months preceding interview were compared according to whether they knew their HIV serostatus for at least 6 months prior to interview. RESULTS: In comparison with IDU who had never been tested, IDU who knew that they were HIV-seropositive were more likely to always use condoms [rate ratio (RR) = 3.1; 95% confidence interval (CI), 2.3-4.2] and never gave their used equipment to other IDU (RR = 1.3; 95% CI, 1.2-1.5), but did not differ with regard to safe injecting practices (RR = 1.0; 95% CI, 0.9-1.1). Compared with IDU who had never been tested, IDU with a negative test tended to inject drugs safely more often (RR = 1.1; 95% CI, 1.02-1.2). There was no significant difference in condom use (RR = 0.7; 95% CI, 0.5-1.1). CONCLUSION: These results indicate that the knowledge of HIV serostatus may help to reduce HIV transmission from HIV-positive IDU to others through safer injecting and sexual behaviour. However, for HIV-negative IDU safer injecting behaviour appears to be better accepted than safer sexual behaviour.

Adult↗
PubMed1994

Risk factors for the transition from noninjection to injection drug use and accompanying AIDS risk behavior in a cohort of drug users.

Although injection drug users have been shown to reduce high-risk injection behaviors in response to the epidemic of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS), the total elimination of risk behaviors has not been achieved. A more fundamental preventive measure may be to keep drug users from starting to inject at all. The authors selected 184 drug users from a cohort study in Amsterdam, the Netherlands, from 1985 to 1992, who had reported at entry to the study that they either had never injected drugs or had injected for the last time more than 1 year before the initial visit. Over a 5-year follow-up period, impressively high cumulative rates of transition to injection drug use were found in both groups. Among drug users who had never injected drugs, 30% began injecting; among those who had injected drugs 1-5 years before their entry into the study, 70% started injecting again. These rates were stable over time. The authors also confirmed that new injectors are at high risk of acquisition of HIV infection. With the use of a survival and a nested case-control analysis, the following independent risk factors that increased the likelihood of starting to inject were found: previous injecting history, ethnicity other than Surinamese/Antillean, regular long-term use of cocaine, current use of heroin, and a current steady sexual relationship with a partner who injects drugs. Given the high and stable incidence of initiation of injection among drug users within the cohort study, the prevention of this behavior appears to be difficult. Additional studies are needed to determine effective prevention strategies.

Acquired Immunodeficiency Syndrome↗
PubMed2007

Staff attitudes towards working with drug users: development of the Drug Problems Perceptions Questionnaire.

AIM: To evaluate the psychometric properties of an adaptation of the Alcohol and Alcohol Problems Perceptions Questionnaire to measure the attitudes of staff to working with drug users (the DDPPQ). DESIGN: Postal survey: a questionnaire was mailed to participants on two occasions. SETTING: A large urban National Health Service (NHS) mental health service. PARTICIPANTS: A stratified random sample of medical staff, clinical psychologists, occupational therapists and nurses (n = 672) who work within generic mental health, adolescent psychiatry, forensic psychiatry and alcohol and drug services. Response rate at Time 1 was 56% and 68% at Time 2. MEASUREMENTS: A structured demographic questionnaire; individual item and total scores for the DDPPQ administered on two occasions 4 weeks apart; data relating to the content validity of the instrument. FINDINGS: A principal component analysis confirmed the DDPPQ's construct validity and participants confirmed its content validity. Following analysis of the instrument's test-retest reliability and its principal component structure it was reduced to a 20-item scale. Its five subscales related to role adequacy, role support, job satisfaction, role-specific self-esteem and role legitimacy. CONCLUSION: The refined DDPPQ was shown to be a valid and reliable tool which can be used to measure attitudes of people in relation to working with drug users.

Alcoholism↗
PubMed1995

Modeling incidence rate ratio and rate difference: additivity or multiplicativity of human immunodeficiency virus parenteral and sexual transmission among intravenous drug users. Northern Italy Seronegative Drug Addicts Study.

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

Blood-Borne Pathogens↗
PubMed2000

[Evolution of the prevalence of HIV infection and risk behavior of drug injection among intravenous drug users infected or not infected by HIV in 3 Spanish cities. Working Group of Physicians of the World for the monitoring of HIV infection and risk behaviors in intravenous drug users].

OBJECTIVE: To know the evolution of HIV prevalence and risk behavior practices of drug injection in three spanish cities on the basis of the serologic status of injecting drug users. METHODS: Cross-sectional surveys among users in syringe interchange programmes. RESULTS: HIV prevalence (self-reported) decreased in Madrid from 50% (1992) down to 41% (1996) (p = 0.01) and did not change in Seville and Valencia from 1994 to 1996. Among HIV-positive injecting drug users, a decrease was observed in the practice of giving and taking used syringes in the three cities, although this decrease reached a statistically significance (p = 0.006) only for giving in Valencia from 1994 to 1996 and was almost significant (p = 0.08) for taking in Madrid from 1993 to 1996. Among HIV-negative injecting drug users, no decreases were observed in the practice of giving and taking used syringes and even a significant increase in giving syringes in Seville was recorded (p = 0.01) from 1994 to 1996. CONCLUSIONS: HIV prevalence among injecting drug users is stabilized or decreasing in the three studied cities. The prevalence of injecting risk behavior evolves differently according to the serologic status.

Adult↗