Emcdda Documentation Centre

EMCDDA DOCUMENTATION CENTRE INFORMATION BULLETIN

INFECTIOUS DISEASES

9 September 2016 ______

JOURNAL ARTICLES – Hepatitis

Severe psychosis, drug dependence, and hepatitis C related to slamming mephedrone Dolengevich-Segal H, Rodríguez-Salgado B, Gómez-Arnau J, Sánchez-Mateos D Case Reports in Psychiatry 2016:8379562

Background Synthetic cathinones (SCs), also known as "bath salts," are β-ketone amphetamine compounds derived from cathinone, a psychoactive substance found in Catha edulis. Mephedrone is the most representative SC. Slamming is the term used for the intravenous injection of these substances in the context of chemsex parties, in order to enhance sex experiences. Using IV mephedrone may lead to diverse medical and psychiatric complications like psychosis, aggressive behavior, and suicide ideation. Case We report the case of a 25-year-old man admitted into a psychiatric unit, presenting with psychotic symptoms after slamming mephedrone almost every weekend for the last 4 months. He presents paranoid delusions, intense anxiety, and visual and kinesthetic hallucinations. He also shows intense craving, compulsive drug use, general malaise, and weakness. After four weeks of admission and antipsychotic treatment, delusions completely disappear. The patient is reinfected with hepatitis C. Discussion Psychiatric and medical conditions related to chemsex and slamming have been reported in several European cities, but not in Spain. Psychotic symptoms have been associated with mephedrone and other SCs' consumption, with the IV route being prone to produce more severe symptomatology and addictive conducts. In the case we report, paranoid psychosis, addiction, and medical complications are described. [FULL TEXT AVAILABLE]

JOURNAL ARTICLES – HIV/AIDS

Does substance use compromise depression treatment in persons with HIV? Findings from a randomized controlled trial Grelotti DJ, Hammer GP, Dilley JW, Karasic DH, Sorensen JL, Bangsberg DR, Tsai AC AIDS Care 2 September 2016 [Epub ahead of print]

Depression and substance use are significant obstacles to effective HIV care. Using data derived from a randomized controlled trial of persons with HIV who are homeless or marginally housed, this study assesses the utility of antidepressant treatment among persons with HIV, depression, and active substance use. Participants were diagnosed with depressive disorders and randomly assigned to receive directly observed therapy with fluoxetine or a referral to community mental health treatment. Assessments, conducted at baseline and every 3 months over a 9-month period, included the Hamilton Rating Scale for Depression, the Beck Depression Inventory II, and self-report of alcohol, crack, cocaine, heroin, or methamphetamine use in the past 90 days. To investigate the effect of antidepressant treatment in the setting of active substance use, the authors fit mixed-effects linear regression models to estimate the effect of directly observed fluoxetine on depressive symptom severity after stratifying by any alcohol use or any illicit drug use. To investigate whether alcohol use or illicit drug use moderated the antidepressant treatment response, the authors examined the interaction terms. The effect of directly observed fluoxetine treatment on depression symptom severity was statistically significant irrespective of alcohol use status. When stratified by illicit drug use status, the effect of directly observed fluoxetine treatment on depression symptom severity was statistically significant only among persons who did not use illicit drugs. The interaction terms were not statistically significant. This study found a benefit of antidepressant treatment in persons with HIV, depression, and alcohol use. In addition, this study found no evidence that either alcohol use or illicit drug use moderates the antidepressant treatment response. Altogether, these findings support the use of antidepressant medication in this population. The public health impact of research in this area is significant given the known adverse effects of depression on HIV-related health outcomes.

Time since migration and HIV risk behaviors among Puerto Ricans who inject drugs in New York City Gelpí-Acosta, C, Pouget, E R, Reilly, K H, Hagan, H, Neaigus, A, Wendel, T, Marshall D M Substance Use and Misuse 51, 7, p.870-81, 2016

Background: Among people who inject drugs (PWID) in the United States, those who initiated drug injection in Puerto Rico (immigrant Puerto Rican PWID) engage in more injection and sexual risk behaviors, and have higher HIV incidence than non-Hispanic whites. Objective: Understand the persistence of these HIV behaviors. Methods: In a cross-sectional study conducted in New York City (NYC) in 2012 (National HIV Behavioral Surveillance), PWID aged ≥18 years were recruited using Respondent- Driven Sampling, interviewed, and tested for HIV. Participants were categorized into 5 different groups: (1) US-born non-Hispanic PWID, (2) US-born Puerto Rican PWID, (3) recent immigrant Puerto Rican PWID (≤3 years in NYC), (4) medium-term immigrant Puerto Rican PWID (>3 and ≤10 years in NYC), and (5) long-term immigrant Puerto Rican PWID (>10 years in NYC). We examined the relationship between time since migrating on sexual and injection risk behaviors among immigrant Puerto Rican PWID, compared with U.S.-born Puerto Rican PWID and US-born non-Hispanic PWID. Adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) were estimated using logistic regression. Results: A total of 481 PWID were recruited. In adjusted analyses using US-born non-Hispanic PWID as the comparison group, syringe sharing was significantly more likely among medium-term immigrants; and unprotected sex with casual partners was more likely among recent and long-term immigrants. Conclusions: The risk-acculturation process for immigrant Puerto Rican PWID may be nonlinear and may not necessarily lead to risk reduction over time. Research is needed to better understand this process. [FULL TEXT AVAILABLE]

HIV risk, substance use, and suicidal behaviors among Asian American lesbian and bisexual women Lee, J; Hahm, H C AIDS Education & Prevention, 24, 6, p.549-63, 2012

The authors examined the association between lesbian/bisexual identity and three risky health behaviors (HIV risk, substance use, and suicidal behaviors) in a sample of Asian American women. This cross-sectional study was designed to investigate the prevalence of HIV risk behaviors and mental health functioning among unmarried Chinese, Korean, and Vietnamese women ages 18 to 35 who are children of immigrants (N = 701), using computer-assisted survey interviews (CASI). Approximately one out of five Asian American women in the sample identified themselves as a lesbian and bisexual woman (18%). Overall, Asian American lesbian and bisexual women reported higher proportions of risky health behaviors than did their exclusively heterosexual counterparts. The odds of engaging in HIV risk behaviors, using substances, and experiencing suicidal ideation were two to three times higher for lesbian and bisexual women than for exclusively heterosexual women. These findings suggest that rigorous screening is necessary for identifying women in this lesbian/bisexual subgroup in order to provide them with better assessment and services. [FULL TEXT AVAILABLE]

Daily alcohol use as an independent risk factor for HIV seroconversion among people who inject drugs Young SV, Wood E, Dong H, Kerr T, Hayashi K Addiction 111, 8, p.1360-1365, 2016

Aims: To estimate the relationship between daily alcohol use and HIV seroconversion among people who inject drugs (PWID) in a Canadian setting. Design And Setting: Data from an open prospective cohort study of PWID in Vancouver, Canada, recruited via snowball sampling and street outreach between May 1996 and November 2013. An interviewer-administered questionnaire including standardized behavioural assessment and HIV antibody testing were conducted semi-annually. Baseline HIV-seronegative participants completing ≥ 1 follow-up visits were eligible for the present analysis. Participants: A total of 1683 eligible participants, were followed for a median of 79.8 [interquartile range (IQR) = 33.3-119.1] months. Measurements: The primary end-point was time to HIV seroconversion, with the date of HIV seroconversion estimated as the mid-point between the last negative and the first positive antibody test results. The primary explanatory variable was self-reported daily alcohol use in the previous 6 months assessed semiannually. Other covariates considered included demographic, behavioural, social/structural and environmental risk factors for HIV infection among PWID (e.g. daily cocaine injection, methadone use, etc.). Findings: Of 1683 PWID, there were 176 HIV seroconversions during follow-up with an incidence density of 1.5 [95% confidence interval (CI) = 1.3-1.7] cases per 100 person-years. At baseline, 339 (20.1%) consumed alcohol at least daily in the previous 6 months. In multivariable extended Cox regression analyses, daily alcohol use remained associated independently with HIV seroconversion (adjusted hazard ratio: 1.48; 95% CI = 1.00-2.17). Conclusions: Daily alcohol use appears to be an independent risk factor for HIV seroconversion among our cohort of PWID.

JOURNAL ARTICLES – Other Conditions / Issues

T cell distribution in relation to HIV/HBV/HCV coinfections and intravenous drug use Kallas E, Huik K, Türk S, Pauskar M, Jõgeda EL, Šunina M, Karki T, Des Jarlais D, Uusküla A, Avi R, Lutsar I Viral Immunology 26 August 2016 [Epub ahead of print]

Intravenous drug use (IDU) is one of the most important transmission routes for blood borne viruses, including human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). These infections alter the subset distributions of T cells; however, knowledge of such effects during HIV, HBV, and or HCV coinfection is limited. Therefore, we aimed to evaluate any associations between T cell distribution and the presence of HIV, HBV, and HCV coinfections among persons who inject drugs (PWID). Blood samples from 88 Caucasian PWID (mean age 30; 82% male) and 47 age-matched subjects negative for all three infections (mean age of 29; 83% male) were analyzed. The T cell markers CD3, CD4, CD8, CD45RA, CCR7, HLA-DR, and CCR5 were assessed using flow cytometry. Of the PWID, 40% were HIV+HBV+HCV+, 20% HBV+HCV+, 19% HCV+, and 13% negative for all three infections. The HIV+HBV+HCV+ PWID had lower percentages of CD4+ and higher percentages of CD8+ cells compared to triple negative PWID (p < 0.001 in all cases). The only difference between HBV+HCV+ with triple negative PWID was the lower CD4+ cell percentages among the former (52.1% and 58.6%, p = 0.021). Triple negative PWID had higher immune activation and number of CCR5+ cells compared to the controls. We suggest that the altered T cell subset distribution among PWID is mainly triggered by HIV infection and or IDU, while HBV and or HCV seropositivity has minimal additional effects on CD4+ cell distribution.

Increasing infectious endocarditis admissions among young people who inject drugs Wurcel, A G; Anderson, J E; Chui, K K H; Skinner, S; Knox, T A; Snydman, D R; Stopka, T J Open Forum Infectious Diseases, 2016, 3, 3 - doi:10.1093/ofid/ofw157

People who inject drugs (PWID) are at risk for infective endocarditis (IE). Hospitalization rates related to misuse of prescription opioids and heroin have increased in recent years, but there are no recent investigations into rates of hospitalizations from injection drug use-related IE (IDU-IE). Using the Health Care and Utilization Project National Inpatient Sample (HCUP-NIS) dataset, we found that the proportion of IE hospitalizations from IDU-IE increased from 7% to 12.1% between 2000 and 2013. Over this time period, we detected a significant increase in the percentages of IDU-IE hospitalizations among 15- to 34-year-olds (27.1%–42.0%; P < .001) and among whites (40.2%–68.9%; P < .001). Female gender was less common when examining all the IDU-IE (40.9%), but it was more common in the 15- to 34-year-old age group (53%). Our findings suggest that the demographics of inpatients hospitalized with IDU-IE are shifting to reflect younger PWID who are more likely to be white and female than previously reported. Future studies to investigate risk behaviors associated with IDU-IE and targeted harm reduction strategies are needed to avoid further increases in morbidity and mortality in this rapidly growing population of young PWID. [FULL TEXT AVAILABLE]

Epidemiology of syphilis infection among drug users at methadone maintenance treatment clinics in China: systematic review and meta-analysis Wang BX, Zhang L, Wang YJ, Yan JW, Wan YN, Peng WJ, Wang J International Journal of STD & AIDS 25 (8) p.550-8, 2014

Illicit drug trade has re-emerged in China since 1979 and the number of drug addicts had increased. Syphilis is mainly spread through sexual contact and blood. The incidence of syphilis is high among drug users. Methadone maintenance treatment (MMT) clinics have been implemented in China since 2004. The aim of this study was to estimate the prevalence and risk factors of syphilis among drug users at MMT clinics in China between 2004 and 2013. Chinese and English databases (CBM, CNKI, Weipu, Pubmed) of literature were searched for studies reporting syphilis among drug users in MMT clinics from 2004 to 2013. The prevalence estimates and risk factors were summarized through a systematic review and meta-analysis of published literatures. In all, 29 eligible articles with a total of 8899 drug users, were selected in this review. The pooled prevalence of syphilis infection was 7.78% (95%CI: 5.83%- 9.99%). The meta-analyses demonstrated significant differences in syphilis infection rates between men and women (OR = 0.34 [95%CI: 0.26-0.45]) but not between drug users and non-intravenous drug users (OR = 0.82 [95%CI: 0.51-1.32]). Enhanced detection of syphilis and health promotion is warranted in MMT clinics in China.

Hospitalizations for heart infection related to drug injection rising across the US http://www.eurekalert.org/pub_releases/2016-09/tuhs-hfh082916.php

Study finds heart infections increasing among younger injection drug users Serious heart infections caused by injection drug use are on the rise, particularly among young whites, according to a new study published in Open Forum Infectious Diseases, now available online | Medical Xpress, USA http://medicalxpress.com/news/2016-09-heart-infections-younger-drug-users.html

New research supports hep C treatment for people who use drugs Global health experts are today are calling for the removal of restrictions preventing people who use drugs from accessing new hepatitis C cures. So long as these restrictions exist, the goal of disease elimination will remain out of reach, they say | EurekAlert, USA http://www.eurekalert.org/pub_releases/2016-09/infh-nrs090616.php