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1.
J Craniomaxillofac Surg ; 47(12): 1918-1921, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31812305

RESUMO

Krokodil is a cheap and effective home-made substitute for heroin. It is widely used over the territory of the former USSR (Russia, Ukraine, Armenia and others). Krokodil drug-related midface ON often occurs as a complication of maxillary ON. Treatment of Krokodil drug-related ON of the midface is challenging. It is difficult to determine the ON zone preoperatively and intraoperatively, due to the complex anatomy of the midface and the different periods of the disease onset in different areas. The aim of this study is to show variations of the clinical course and treatment options of Krokodil drug-related ON of the midface. In this study, 3 cases of Krokodil drug-related midface ON are reported. The main clinical feature of midface ON is extraoral fistula in the midfacial zone with purulent discharge or extraoral exposure of zygomatic bone. Surgery is the main treatment method for Krokodil drug-related midface osteonecrosis. Surgery includes necrotic bone removal and defect closure. Usually an extraoral approach is used to expose necrotic bone. Intraoral maxillary sinus floor defect is closed with the use of a buccal fat pad to prevent formation of oroantral communication. Drug withdrawal, radical necrectomy, and proper closure of formed defects are the main factors that lead to successful treatment of Krokodil drug-related midface ON patients.


Assuntos
Codeína/análogos & derivados , /química , Necrose/induzido quimicamente , Osteonecrose/induzido quimicamente , Levantamento do Assoalho do Seio Maxilar , Abuso de Substâncias por Via Intravenosa/complicações , Adulto , Codeína/efeitos adversos , Codeína/química , Humanos , Masculino , Maxila , Pessoa de Meia-Idade , Necrose/cirurgia , Osteonecrose/cirurgia , Resultado do Tratamento
2.
BMC Infect Dis ; 19(1): 918, 2019 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-31699053

RESUMO

BACKGROUND: In recent years, the number of infective endocarditis (IE) cases associated with injection drug use has increased. Clinical guidelines suggest deferring surgery for IE in people who inject drugs (PWID) due to a concern for worse outcomes in comparison to non-injectors (non-PWID). We performed a systematic review and meta-analysis of long-term outcomes in PWID who underwent cardiac surgery and compared these outcomes to non-PWID. METHODS: We systematically searched for studies reported between 1965 and 2018. We used an algorithm to estimate individual patient data (eIPD) from Kaplan-Meier (KM) curves and combined it with published individual patient data (IPD) to analyze long-term outcomes after cardiac surgery for IE in PWID. Our primary outcome was survival. Secondary outcomes were reoperation and mortality at 30-days, one-, five-, and 10-years. Random effects Cox regression was used for estimating survival. RESULTS: We included 27 studies in the systematic review and 19 provided data (KM or IPD) for the meta-analysis. PWID were younger and more likely to have S. aureus than non-PWID. Survival at 30-days, one-, five-, and 10-years was 94.3, 81.0, 62.1, and 56.6% in PWID, respectively; and 96.4, 85.0, 70.3, and 63.4% in non-PWID. PWID had 47% greater hazard of death (HR 1.47, 95% CI, 1.05-2.05) and more than twice the hazard of reoperation (HR 2.37, 95% CI, 1.25-4.50) than non-PWID. CONCLUSION: PWID had shorter survival that non-PWID. Implementing evidence-based interventions and testing new modalities are urgently needed to improve outcomes in PWID after cardiac surgery.


Assuntos
Endocardite/diagnóstico , Abuso de Substâncias por Via Intravenosa/complicações , Procedimentos Cirúrgicos Cardíacos , Endocardite/etiologia , Endocardite/mortalidade , Humanos , Estimativa de Kaplan-Meier , Modelos de Riscos Proporcionais , Infecções Estafilocócicas/diagnóstico , Resultado do Tratamento
3.
AIDS Behav ; 23(10): 2641-2653, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31297684

RESUMO

In the United States (U.S.), more than 12 million women reported illicit drug use in the past month. Drug use has been linked to increased risk for HIV, but little is known about the uptake of HIV pre-exposure prophylaxis (PrEP) to prevent HIV among women who use drugs (WWUD). Following the PRISMA guideline, we conducted a multi-database literature search to assess engagement along the PrEP care continuum among WWUD in the U.S. Seven studies with a total of 755 women were included in the review: 370 (49%) Black, 126 (16.7%) Hispanics, and 259 (34.3%) Whites. Employing random-effect models, data indicate 20.6% (95% CI 8.7%, 32.4%) of WWUD were aware of PrEP, and 60.2% (95% CI 52.2%, 68.2%) of those aware were also willing to use PrEP. Notwithstanding study limitations, our findings suggest there may be potential to increase PrEP uptake among WWUD, but efforts must first concentrate on improving PrEP awareness among this population.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Profilaxia Pré-Exposição , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adulto , Conscientização , Continuidade da Assistência ao Paciente , Feminino , Humanos , Abuso de Substâncias por Via Intravenosa/complicações , Estados Unidos
4.
Arch Virol ; 164(10): 2493-2504, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31346769

RESUMO

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


Assuntos
Usuários de Drogas , Infecções por HIV/complicações , Hepatite C Crônica/epidemiologia , Hepatite C Crônica/patologia , RNA Viral/sangue , Abuso de Substâncias por Via Intravenosa/complicações , Adulto , Idoso , Feminino , Genótipo , Técnicas de Genotipagem , Hospitais Universitários , Humanos , Irã (Geográfico) , Leucócitos Mononucleares/virologia , Masculino , Pessoa de Meia-Idade , Plasma/virologia , Reação em Cadeia da Polimerase , Polimorfismo de Fragmento de Restrição , Prevalência , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Adulto Jovem
5.
Am J Dermatopathol ; 41(8): e84-e86, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31335429

RESUMO

Crospovidone, a polymer of poly N-vinyl-2-pyrrolidone, is an inert insoluble disintegrant found in pharmaceutical tablets. This material has been encountered in the lungs of intravenous drug users and embolized with other components such as talc and microcrystalline cellulose. More recently, crospovidone has also been described in the gastrointestinal tract. We present 2 cases of cutaneous crospovidone deposition resulting from subcutaneous injection of crushed tablets, commonly known as "skin popping." Clinical presentation includes painful, inflamed papules, nodules, or ulcers with overlying eschar. Crospovidone has a distinct and reproducible histochemical staining profile. Histologic recognition of this material is important because it can guide clinicians in their diagnosis and management decisions.


Assuntos
Analgésicos Opioides/efeitos adversos , Corpos Estranhos/etiologia , Transtornos Relacionados ao Uso de Opioides/complicações , Excipientes Farmacêuticos/efeitos adversos , Povidona/efeitos adversos , Pele/química , Abuso de Substâncias por Via Intravenosa/complicações , Adulto , Analgésicos Opioides/análise , Composição de Medicamentos , Feminino , Corpos Estranhos/patologia , Humanos , Injeções Subcutâneas , Excipientes Farmacêuticos/análise , Povidona/análise , Pele/patologia , Comprimidos
6.
Am J Forensic Med Pathol ; 40(4): 386-390, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31305278

RESUMO

The injection of drugs of abuse causes many millions of deaths each year; deaths are mostly due to fatal overdose and the trauma and infection caused by repeated injections. The scientific literature widely reports cases of infected pseudoaneurysm in injecting drug abusers; however, most of these autopsy cases deal with the rupture of pseudoaneurysm of the femoral artery. We present fatal hemorrhagic shock in a heroin-cocaine abuser subsequent to rupture of pseudoaneurysm of the brachial artery; the man collapsed just before injecting himself with a dose of heroin-cocaine (speedball).


Assuntos
Falso Aneurisma/patologia , Aneurisma Roto/patologia , Artéria Braquial/patologia , Choque Hemorrágico/etiologia , Abuso de Substâncias por Via Intravenosa/complicações , Adulto , Usuários de Drogas , Evolução Fatal , Humanos , Masculino
7.
AIDS Behav ; 23(12): 3257-3266, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31313095

RESUMO

A syringe services program (SSP) was established following the Indiana HIV outbreak among persons who inject drugs (PWID) in Scott County. Among Indiana-based PWID, we examined injection behaviors associated with HIV status, SSP use after its establishment, and changes in injection behaviors after the outbreak response. During 2016, we interviewed 200 PWID and assessed injection behaviors before the response by HIV status. We reported injection behaviors prior to the response and used Fisher's exact Chi square tests (P < 0.05) to assess differences by HIV status. Next, among persons who injected both before (July-December 2014) and after (past 30 days) the response, we (1) reported the proportion of persons who used the SSP to obtain sterile syringes, and assessed differences in SSP use by HIV status using Fisher's exact Chi square tests; and (2) compared distributive and receptive sharing of injection equipment and disposal of syringes before and after the outbreak response, and assessed statistical differences using McNemar's test. We also compared injection behaviors before and after the response by HIV status. Injecting extended release oxymorphone (Opana® ER); receptive sharing of syringes and cookers; and distributive sharing of cookers, filters, or water before the response were associated with HIV infection. SSP use was high (86%), particularly among HIV-positive compared with HIV-negative persons (98% vs. 84%). Injection equipment sharing decreased and safe disposal of used syringes increased after the response, especially among HIV-positive persons. Injection equipment sharing contributed to the outbreak. High SSP use following the response, particularly among HIV-positive persons, contributed to decreased high-risk injection practices.


Assuntos
Surtos de Doenças , Transmissão de Doença Infecciosa/prevenção & controle , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Programas de Troca de Agulhas , Assunção de Riscos , Abuso de Substâncias por Via Intravenosa/complicações , Adolescente , Adulto , Controle de Doenças Transmissíveis/métodos , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/transmissão , Humanos , Indiana/epidemiologia , Injeções , Masculino , Pessoa de Meia-Idade , Uso Comum de Agulhas e Seringas , Saúde Pública , Abuso de Substâncias por Via Intravenosa/epidemiologia , Seringas
9.
MMWR Morb Mortal Wkly Rep ; 68(26): 583-586, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31269011

RESUMO

During 2014-2017, CDC Emerging Infections Program surveillance data reported that the occurrence of invasive methicillin-resistant Staphylococcus aureus (MRSA) infections associated with injection drug use doubled among persons aged 18-49 years residing in Monroe County in western New York.* Unpublished surveillance data also indicate that an increasing proportion of all Candida spp. bloodstream infections in Monroe County and invasive group A Streptococcus (GAS) infections in 15 New York counties are also occurring among persons who inject drugs. In addition, across six surveillance sites nationwide, the proportion of invasive MRSA infections that occurred in persons who inject drugs increased from 4.1% of invasive MRSA cases in 2011 to 9.2% in 2016 (1). To better understand the types and frequency of these infections and identify prevention opportunities, CDC and public health partners conducted a rapid assessment of bacterial and fungal infections among persons who inject drugs in western New York. The goals were to assess which bacterial and fungal pathogens most often cause infections in persons who inject drugs, what proportion of persons who inject use opioids, and of these, how many were offered medication-assisted treatment for opioid use disorder. Medication-assisted treatment, which includes use of medications such as buprenorphine, methadone, and naltrexone, reduces cravings and has been reported to lower the risk for overdose death and all-cause mortality in persons who use opioids (2,3). In this assessment, nearly all persons with infections who injected drugs used opioids (97%), but half of inpatients (22 of 44) and 12 of 13 patients seen only in the emergency department (ED) were not offered medication-assisted treatment. The most commonly identified pathogen was S. aureus (80%), which is frequently found on skin. Health care visits for bacterial and fungal infections associated with injection opioid use are an opportunity to treat the underlying opioid use disorder with medication-assisted treatment. Routine care for patients who continue to inject should include advice on hand hygiene and not injecting into skin that has not been cleaned or to use any equipment contaminated by reuse, saliva, soil, or water (4,5).


Assuntos
Infecções Bacterianas/epidemiologia , Micoses/epidemiologia , Vigilância da População , Abuso de Substâncias por Via Intravenosa/complicações , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , New York/epidemiologia , Adulto Jovem
10.
BMC Infect Dis ; 19(1): 515, 2019 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-31185925

RESUMO

BACKGROUND: Most of studies on the relationship between drug use and HIV have focused largely on people who inject drugs. Non-injecting drug use is much more common than injecting drug use, and although it can also predispose people to HIV infection, it is not widely explored. We therefore conducted this study to explore the prevalence of HIV and identify risk factors for HIV infection among people who use non-injecting drugs (PWUD) in Cambodia. METHODS: This cross-sectional study was conducted in 2017. The Respondent Driven Sampling method was used to recruit the study participants who were interviewed face-to-face using a structured questionnaire. Blood samples were collected for HIV and syphilis testing. A multivariable logistic regression analysis was conducted to identify risk factors associated with HIV infection. RESULTS: In total, 1367 PWUD were included in this study, whose mean age was 28.0 (SD = 7.7) years. The majority (95.1%) of the participants used methamphetamine. The prevalence of HIV was 5.7, and 35.2% of the identified HIV-positive PWUD were not aware of their status prior to the survey. After adjustment for other covariates, HIV infection remained significantly associated with being in the age group of ≥35 (AOR = 2.34, 95% CI = 1.04-6.11), having lower level of formal education of ≤ 6 years (AOR = 2.26, 95% CI = 1.04-5.15), living on the streets (AOR = 2.82, 95% CI = 1.10-7.23), perception that their HIV risk was higher as compared to that of the general population (AOR = 3.18, 95% CI = 1.27-8.62), having used injecting drugs in lifetime (AOR = 3.8, 95% CI = 1.36-4.56), and having cuts or sores around the genital area in the past 12 months (AOR = 3.42, 95% CI = 1.09-6.33). CONCLUSIONS: The prevalence of HIV among PWUD in this study was more than 10 times higher than the prevalence in the general adult population. The findings reveal a higher vulnerability to HIV infection among specific sub-populations of PWUD, such as those who are homeless, who may benefit from tailored interventions that respond to their specific needs. To enhance HIV case finding, stratification of PWUD to facilitate HIV risk profiling based on socio-economic profiles and drug injection history is recommended.


Assuntos
Usuários de Drogas/estatística & dados numéricos , Infecções por HIV/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Adulto , Camboja/epidemiologia , Estudos Transversais , Feminino , HIV , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Abuso de Substâncias por Via Intravenosa/complicações , Abuso de Substâncias por Via Intravenosa/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/complicações , Inquéritos e Questionários/estatística & dados numéricos , Adulto Jovem
11.
Implement Sci ; 14(1): 62, 2019 06 14.
Artigo em Inglês | MEDLINE | ID: mdl-31200757

RESUMO

BACKGROUND: People who inject drugs (PWID) in Kazakhstan face many barriers to HIV testing as well as to accessing HIV care, to retention in HIV care, and to initiating and adhering to anti-retroviral treatment (ART). Needle and syringe programs (NSPs) are an opportune setting for integrated interventions to link PWID to HIV care. METHODS: This Hybrid Type II study employs a stepped-wedge design to evaluate both effectiveness and implementation outcomes of Bridge, an intervention to identify, test, and link HIV-positive PWID to HIV care. The study is conducted at 24 NSPs in three different regions of Kazakhstan, to assess outcomes on the individual, organizational, and policy levels. DISCUSSION: This trial responds to an identified need for new models of HIV service delivery for PWID through harm reduction settings. TRIAL REGISTRATION: NCT02796027 on June 10, 2016.


Assuntos
Sorodiagnóstico da AIDS , Assistência à Saúde/normas , Infecções por HIV/transmissão , Melhoria de Qualidade , Abuso de Substâncias por Via Intravenosa/complicações , Adulto , Aconselhamento , Feminino , Humanos , Cazaquistão/epidemiologia , Masculino , Prevalência , Encaminhamento e Consulta , Projetos de Pesquisa , Rede Social , Abuso de Substâncias por Via Intravenosa/epidemiologia
12.
Adv Skin Wound Care ; 32(7): 301-310, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31232837

RESUMO

GENERAL PURPOSE: To explore skin and soft-tissue infections and vascular damage in persons who inject drugs and relate these changes to wound development and care. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant should be better able to:1. Review the issues surrounding wound infections in persons who inject drugs.2. Describe the risk factors and manifestations of wound infections in persons who inject drugs.3. Summarize the treatment options for wound infections in persons who inject drugs. ABSTRACT: The number of persons who inject drugs (PWIDs) is increasing. The literature has placed a substantial focus on the association between injection drug use and the transmission of blood-borne viral infections such as HIV and hepatitis C, but there is less extant research on other injuries such as skin and soft tissue infections (SSTIs), vascular damage, and associated wounds. Both SSTIs and vascular injury can result in marked morbidity and mortality and wounds that are slow to heal, likely to reoccur, and lifelong. The aims of this article are to (1) explore SSTIs and vascular damage in PWIDs and (2) relate these changes to wound development and care. Providers must address the health and psychosocial problems of PWIDs; take physical, psychosocial, and substance use histories; and develop multifocal plans of care. Finally, care must be provided in a nonjudgmental manner.


Assuntos
Higiene da Pele/métodos , Infecções dos Tecidos Moles/etiologia , Abuso de Substâncias por Via Intravenosa/terapia , Doenças Vasculares/etiologia , Ferimentos e Lesões/etiologia , Ferimentos e Lesões/terapia , Educação Médica Continuada , Feminino , Humanos , Masculino , Infecções dos Tecidos Moles/fisiopatologia , Infecções dos Tecidos Moles/terapia , Abuso de Substâncias por Via Intravenosa/complicações , Abuso de Substâncias por Via Intravenosa/epidemiologia , Doenças Vasculares/terapia , Infecção dos Ferimentos/etiologia , Infecção dos Ferimentos/terapia
14.
Reprod Health ; 16(Suppl 1): 59, 2019 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-31138238

RESUMO

BACKGROUND: Despite being a priority population for HIV prevention and harm reduction programs, the sexual and reproductive health (SRH) needs of women who inject drugs are being overlooked. Furthermore, models for providing integrated SRH, HIV, and harm reduction services for women who inject drugs are rare. This article reports the development of community-based outreach services that integrated family planning and other SRH interventions with HIV and harm reduction services for this population in coastal Kenya. METHODS: Using mixed-methods implementation research, a qualitative baseline needs assessment was conducted with women who inject drugs and harm reduction stakeholders using a combination of in-depth interviews and focus group discussions. The qualitative data from participants was subjected to thematic analysis using Nvivo. Based on the baseline needs assessment, integration of SRH into existing HIV and harm reduction services was implemented. After two years of implementation, an evaluation of the program was conducted using a combination of qualitative interviews and review of quantitative service delivery records and other program documents. The process, impacts, and challenges of integrating SRH into a community-based HIV prevention and harm reduction program were identified. RESULTS: This article highlights: 1) low baseline utilization of family planning services among women who inject drugs, 2) improved utilization and high acceptability of outreach-based provision of SRH services including contraception among this population, 3) importance of training, capacity strengthening, technical support and financial resourcing of community-based organizations to integrate SRH into HIV prevention and harm reduction services, and 4) the value of beneficiary involvement, advocacy, and collaboration with other partners in the planning, designing and implementing of SRH interventions for women who inject drugs. CONCLUSIONS: Women who inject drugs in this study had low utilization of family planning and other SRH services, which can be improved through the integration of contraceptive and other SRH interventions into existing outreach-based HIV prevention and harm reduction programs. This integration is acceptable to women who inject drugs, and is programmatically feasible. For successful integration, a rights-based beneficiary involvement, coupled with sustainable technical and financial capacity strengthening at the community level is essential.


Assuntos
Pesquisa Participativa Baseada na Comunidade , Prestação Integrada de Cuidados de Saúde/normas , Usuários de Drogas/estatística & dados numéricos , Infecções por HIV/prevenção & controle , Redução do Dano , Serviços de Saúde Reprodutiva/normas , Abuso de Substâncias por Via Intravenosa/complicações , Prestação Integrada de Cuidados de Saúde/organização & administração , Feminino , HIV/isolamento & purificação , Infecções por HIV/epidemiologia , Infecções por HIV/virologia , Humanos , Quênia/epidemiologia , Serviços de Saúde Reprodutiva/organização & administração , Educação Sexual , Saúde Sexual
16.
PLoS One ; 14(5): e0215570, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31095576

RESUMO

BACKGROUND: An outbreak of HIV infections among people who inject drugs (PWID) started in 2014 in Luxembourg. OBJECTIVES: We conducted phylogenetic and epidemiological analyses among the PWID infected with HIV in Luxembourg or attending the supervised drug consumption facility (SDCF) to understand the main causes of the outbreak. METHODS: Between January 2013 and December 2017, analysis of medical files were performed from all PWID infected with HIV at the National Service of Infectious Diseases (NSID) providing clinical care nationwide. PWID were interviewed at NSID and SDCF using a standardized questionnaire focused on drug consumption and risk behaviours. The national drug monitoring system RELIS was consulted to determine the frequency of cocaine/heroin use. Transmission clusters were analysed by phylogenetic analyses using approximate maximum-likelihood. Univariate and multivariate logistic regression analyses were performed on epidemiological data collected at NSID and SDCF to determine risk factors associated with cocaine use. RESULTS: From January 2013 to December 2017, 68 new diagnosis of HIV infection reported injecting drug use as the main risk of transmission at NSID. The proportion of female cases enrolled between 2013-2017 was higher than the proportion among cases enrolled prior to 2013. (33% vs 21%, p < 0.05). Fifty six viral sequences were obtained from the 68 PWID newly diagnosed for HIV. Two main transmission clusters were revealed: one HIV-1 subtype B cluster and one CRF14_BG cluster including 37 and 9 patients diagnosed since 2013, respectively. Interviews from 32/68 (47%) newly diagnosed PWID revealed that 12/32 (37.5%) were homeless and 27/32 (84.4%) injected cocaine. Increased cocaine injection was indeed reported by the RELIS participants from 53 to 63% in drug users with services contacts between 2012 and 2015, and from 5 to 22% in SDCF users between 2012 and 2016. Compared with PWID who injected only heroin (n = 63), PWID injecting cocaine and heroin (n = 107) were younger (mean of 38 vs 44 years, p≤0.001), reported more frequent piercing (≤0.001), shared and injected drugs more often (p≤0.01), and were more frequently HIV positive (p<0.05) at SDCF using univariate logistic regression analysis. Finally, in the multivariate analysis, use of heroin and cocaine was independently associated with younger age, piercing, sharing of drugs, and regular consumption (p<0.05). CONCLUSIONS: Injecting cocaine is a new trend of drug use in Luxembourg associated with HIV infection in this recent outbreak among PWID.


Assuntos
Cocaína/administração & dosagem , Surtos de Doenças , Infecções por HIV/epidemiologia , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adulto , Cocaína/efeitos adversos , Usuários de Drogas , Feminino , HIV/classificação , HIV/genética , Infecções por HIV/transmissão , Humanos , Injeções , Modelos Logísticos , Luxemburgo , Masculino , Pessoa de Meia-Idade , Filogenia , Estudos Retrospectivos , Abuso de Substâncias por Via Intravenosa/complicações
17.
J Res Health Sci ; 19(1): e00435, 2019 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31133625

RESUMO

BACKGROUND: Transmitting blood-borne diseases is alarming in places with high prevalence of people who inject drugs. This study aimed to determine the prevalence of drug injection and its related predictors among prisoners with a history of tattooing in Iran. STUDY DESIGN: Cross-sectional study. METHODS: By using a census sampling, 5493 prisoners with a history of tattooing of 11988 prisoners participated for hepatitis B and C bio-behavioral surveillance surveys (BSS) in prisons of Iran, during 2015-2016 from 55 prisons in 19 provinces were assessed. The data for the BSS were collected using face-to-face checklist-based interviews. Weighted prevalence and the association between variables and history of drug injection were determined using Chi-square test and adjusted odds ratio (AOR) was estimated through multivariate logistic regression test using survey package. RESULTS: The mean age of participants was 33.9 ±8.3 yr. Most of them were male (96.4%) and had a history of drug use (85.4%). The prevalence of drug injection among drug users was 20.2%, of which 33.9% had a history of shared injection. The prevalence of drug injection among prisoners with a history of tattooing is associated with male gender (P=0.047), age ≥35 yr (P<0.001), being single (P=0.002), being divorced/widow (P=0.039), and a history of imprisonment (P<0.001). CONCLUSION: The prevalence of drug injection increases in the presence of other high-risk behaviors. It is necessary to initiate harm reduction programs and preventive interventions in groups with multiple high-risk behaviors.


Assuntos
Prisões , Assunção de Riscos , Abuso de Substâncias por Via Intravenosa , Tatuagem , Adulto , Fatores Etários , Estudos Transversais , Feminino , Hepatite B/transmissão , Hepatite C/transmissão , Humanos , Injeções Intravenosas/estatística & dados numéricos , Irã (Geográfico)/epidemiologia , Modelos Logísticos , Masculino , Estado Civil , Uso Comum de Agulhas e Seringas/efeitos adversos , Uso Comum de Agulhas e Seringas/estatística & dados numéricos , Razão de Chances , Prevalência , Prisioneiros , Fatores de Risco , Fatores Sexuais , Abuso de Substâncias por Via Intravenosa/complicações , Abuso de Substâncias por Via Intravenosa/epidemiologia
19.
AIDS Behav ; 23(12): 3286-3293, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30955176

RESUMO

High mortality rates among persons with HIV with a history of injection drug use (PWID) are thought to be driven in part by higher rates of external cause-related mortality. We followed 4796 persons aged 18-70 engaged in continuity HIV care from 2001 to 2015 until death or administrative censoring. We compared cause-specific (csHR) and subdistribution hazards (sdHR) of death due to external causes among PWID and persons who acquired their HIV infection through other routes (non-IDU). We standardized estimates on age, sex, race, and HIV-related health status. The standardized csHR for external cause-related death was 3.57 (95% CI 2.39, 5.33), and the sdHR was 3.14 (95% CI 2.16, 4.55). The majority of external cause-related deaths were overdose-related and standardized sdHR was 4.02 (95% CI 2.40, 6.72). Absolute rate of suicide was low but the csHR for PWID compared to non-IDU was most elevated for suicide (6.50, 95% CI 1.51, 28.03). HIV-infected PWID are at a disproportionately increased risk of death due to external causes, particularly overdose and suicide.


Assuntos
Causas de Morte , Infecções por HIV/mortalidade , Abuso de Substâncias por Via Intravenosa/complicações , Suicídio/estatística & dados numéricos , Adolescente , Adulto , Idoso , Instituições de Assistência Ambulatorial , Baltimore/epidemiologia , Usuários de Drogas/psicologia , Feminino , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adulto Jovem
20.
Int J STD AIDS ; 30(5): 472-478, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30999829

RESUMO

Invasive pneumococcal diseases (IPDs) remain a significant cause of morbidity and mortality in human immunodeficiency virus (HIV)-positive individuals despite the widespread use of highly active antiretroviral therapy (HAART) and availability of pneumococcal vaccines. The aim of this study was to measure temporal trends in incidence and risk factors for IPD (defined as culture of Streptococcus pneumoniae from blood, cerebrospinal fluid or both) in a cohort of HIV-positive patients attending an ambulatory HIV care centre in Dublin, Ireland over a 10-year period 2006-2015. Incidence of IPD was determined as events per 100,000 person-years' follow-up. Poisson regression was used to assess linear trend in incidence over time. A nested case-control study (four controls per case) was undertaken to assess risk factors for IPD. Forty-seven episodes of IPD were identified in 42 HIV-positive individuals (median [IQR] age 38 years [33-43], 69% male, 86% injecting drug users (IDUs), median CD4 T-cell count 213 cells/mm3) over 16,008 person-years' follow-up (overall incidence rate 293/100,000 person-years). Three patients had two episodes and one patient had three episodes of IPD during the study period. The overall case fatality rate was 15% (95% confidence interval [CI] 4-24%). The incidence of IPD per 100,000 person-years decreased from 728 (95% CI, 455-1002), to 242 (95% CI, 120-365) to 82 (95% CI, 40-154) in calendar periods 2006-2008, 2009-2012 and 2013-2015, respectively (p < 0.01 for linear trend). Older age (p = 0.02), male gender (p = 0.05), detectable HIV viral load (p < 0.01) and non-receipt of pneumococcal vaccine (p = 0.03) were associated with IPD while IDU as risk of acquisition of HIV was of borderline significance (p = 0.06). HIV-positive individuals remain at greater risk of IPD compared to the general population. Pneumococcal vaccine should be seen as a priority to ensure optimal protection for HIV-positive patients.


Assuntos
Terapia Antirretroviral de Alta Atividade , Infecções por HIV/tratamento farmacológico , Soropositividade para HIV/complicações , Infecções Pneumocócicas/epidemiologia , Streptococcus pneumoniae/isolamento & purificação , Abuso de Substâncias por Via Intravenosa/complicações , Adulto , Terapia Antirretroviral de Alta Atividade/métodos , Estudos de Casos e Controles , Feminino , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Humanos , Incidência , Irlanda/epidemiologia , Masculino , Infecções Pneumocócicas/complicações , Infecções Pneumocócicas/diagnóstico , Vacinas Pneumocócicas/administração & dosagem , Vacinas Pneumocócicas/imunologia , Fatores de Risco , Abuso de Substâncias por Via Intravenosa/epidemiologia
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