Increased risk of bacterial pneumonia in HIV-infected intravenous drug users without AIDS

AIDS ◽  
1988 ◽  
Vol 2 (4) ◽  
pp. 267-272 ◽  
Author(s):  
Peter A. Selwyn ◽  
Anat R. Feingold ◽  
Diana Hartel ◽  
Ellie E. Schoenbaum ◽  
Michael H. Alderman ◽  
...  
Author(s):  
Antti Huuskonen ◽  
Risto Kesävuori ◽  
Peter Raivio

Abstract Background The optimal treatment strategy for intravenous drug users (IVDU) with infective endocarditis (IE) is controversial. We therefore sought to investigate outcomes among IVDUs after surgery for IE. Methods We retrospectively reviewed all 192 consecutive patients who underwent an operation for IE between 2005 and 2016 in the Helsinki University Hospital. Forty-seven patients (24.5%) were IVDUs and 145 (75.5%) were non-IVDUs. Mortality and reinfection and reoperation rates were evaluated. Results IVDUs were younger (29.9 vs. 63.8 years, p < 0.001) and had less cardiovascular risk factors and lower EuroSCORE II (4.3 vs. 7.3%, p < 0.001), but Staphylococcus aureus infection (66.0 vs. 23.4%, p < 0.001), tricuspid valve endocarditis (34.0 vs. 2.8%, p < 0.001), and liver disease (63.8 vs. 2.8%, p < 0.001) occurred more often in IVDUs than in non-IVDUs. Thirty-day mortality of IVDUs was 8.5% and that of non-IVDUs was 6.9% (p = 0.711). Survival of IVDUs at 5 years was 70.8 ± 7.4% and survival of non-IVDUs was 67.9 ± 4.7% (p = 0.678). Relative to an age- and sex-matched general population, IVDUs had 58.6 (95% confidence interval [CI]: 33.7–101.9; p < 0.001) and non-IVUD 4.4 (95% CI: 3.1–6.2; p < 0.001) standardized mortality ratio. IVDUs had a higher reinfection rate at 5 years (25.8 ± 7.7% vs. 3.0 ± 1.7%, p < 0.001) and a higher early reoperation rate than non-IVDUs (10.6 vs. 1.4%, p = 0.003). Conclusions IVDUs and non-IVDUs had comparable survival at 5 years, but IVDUs had a very significantly increased risk of death in comparison to an age- and sex-matched general population. IVDUs had higher reinfection and early reoperation rates. Survival was poor after medically treated reinfection.


1989 ◽  
Vol 19 (1) ◽  
pp. 75-92 ◽  
Author(s):  
Sandra K. Schwarcz ◽  
George W. Rutherford

The acquired immunodeficiency syndrome (AIDS) was first described as a disease of homosexual men. The first cases of AIDS in children were reported in 1982 and involved a transfusion recipient and four infants born to women at increased risk for AIDS. Infants may acquire their infection perinatally or possibly postnatally through infected breast milk. Parenterally acquired infection, through transfusion of blood or blood products, occurs in infants, children, and adolescents. Adolescents are also at risk for infection through sexual transmission and through shared needles among intravenous drug users. By January 1987, 1.4% of the AIDS cases were in children less than 13 years old, and 0.4% were in adolescents 13 to 19 years old. Additionally, 4.4% of the total AIDS cases were reported in 20 to 24 year olds, which most likely reflects infection which occured during adolescence. In children less than 13 years old, infection occurred primarily thorugh perinatal transmission from mothers who were intravenous drug users or sexual partners of intravenous drug users. Adolescent cases of AIDS have followed adult patterns of transmission with most cases resulting from sexual transmission. As the prevalence of infection with the human immunodeficiency virus increases, increases in drug-use-associated transmission in women followed by perinatal transmission to infants and sexual transmission in adolescents seems likely to occur. To prevent further spread, health agencies must develop and target extensive AIDS prevention campaigns at adolescents, young adults, and sexually active women.


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