Alarming increase in HIV infection, hepatitis and tuberculosis in injecting drug users

Abstract

Background: In the last years we observed an alarming increase in the number of newly diagnosed HIV infected intravenous drug users (IDUs) co-infected with hepatitis viruses or with severe bacterial infections. The aim of our study was to assess the prevalence, the demographic and clinical characteristics and the outcome of IDUs diagnosed with HIV, hepatitis and tuberculosis (TB). Materials and Methods: Prospective study on HIV infected IDUs with HCV and TB admitted at '‘Victor Babes” Clinical Hospital between January 2009 and December 2013. Results: Out of 457 HIV infected IDUs, 126 (27.5%) were co-infected with HCV and MTB. The majority were males (84.7%), from urban areas (89.3%), unemployed (81%), with low education level (88%) and a mean age at diagnosis of 30 years (range 16-56). The mean CD4 cell count was 196/mm3 (range 2-1988). Serological markers for HBV were found in 12 patients (9.52%) and for HDV 2 (1.6%). MTB cultures were positive in 61 (48.4%) patients and 2 (1.7%) had multidrug resistant TB. Disseminated and/or extra-pulmonary TB was diagnosed in 45 patients (35.7%). The mortality rate was 11%, higher in patients with disseminated TB and severe immunosuppression. We noticed an important increase in IDUs among newly diagnosed HIV cases, from 3.4% in 2009, to 52.7% in 2013 (p<0.001) and in HIV infected IDUs with TB from 0% in 2009, to 30.2% in 2013 (p< 0.001). Conclusions: The incidence of TB in HIV/HCV co-infected IDUs was high with an ascendant trend in the last years. Most of IDUs with HIV/HCV and TB were males, with a low education level and unemployed. The apparently low proportion of patients co-infected with HBV may be due to insufficient testing for other markers of HBV. TB infection was more frequent in patients with severe immunosuppression, especially in IDUs with disseminated and/or extra-pulmonary disease. In Romania, IDUs are important candidates for acquiring and transmitting HIV infection, viral hepatitis and TB, being difficult to control due to their high risk behaviors. Strengthening of HIV transmission prevention strategies, particularly in identified risk groups, is mandatory.