Illicit drug control has been on the global agenda for more than a century. Infections have long been recognized as one of the most serious complications of drug abuse. Drug users are susceptible to pulmonary, endovascular, skin and soft tissue, bone and joint, and sexually transmitted infections caused by a wide range of bacterial, viral, fungal and protozoal pathogens. In addition, injection drug users are at increased risk for parenterally acquired infections such as human immunodeficiency virus, hepatitis B virus, hepatitis C virus, tetanus and malaria. Factors related to drug use, such as unsterile injection practices, contaminated drug paraphernalia and drug adulterants, increase the exposure to microbial pathogens. Illicit drugs also affect several components of the complex immune system and thus modulate host immunity. In addition, lifestyle practices such as multiple sexual partners, overcrowded housing arrangements and malnutrition serve as co-factors in increasing the risk of infection. In this review we present an overview of the unique aspects of microbial pathogenesis, immune modulation and common infections associated with drug use. We have restricted the definition of drug abuse to the use of illegal drugs (such as opiates, marijuana, cocaine, heroin and amphetamines), not including alcohol and nicotine.

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The majority of the HIV drug resistance (HIVDR) testing studies have focused on subtype B virus. The predominance of subtype C in the Indian subcontinent along with greater access to antiretroviral therapy (ART) necessitates studies on HIVDR genotyping. We determined the prevalence of mutations associated with protease inhibitors (PI), nucleoside reverse transcriptase inhibitors (NRTI), and nonnucleoside reverse transcriptase inhibitors (NNRTI) from plasma of 40 antiretroviral drug-naive study participants in Indian HIV-1 pol gene sequences. Of these, 36 sequences belonged to subtype C, two to subtype A1, and two were subtype A1C recombinants. The heterosexual route was the most common route of transmission. Drug resistance-associated mutations were observed in 10% (4/40) of the study participants. The resistance mutation observed in the protease gene was V82A, whereas in the RT gene, M41L, D67N, M184V, and A98G were documented. This is the first study reporting major protease mutations by genotyping in ART-naive individuals from western India.

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Continuous surveillance of local antimicrobial susceptibility patterns is a must for combating emerging antimicrobial resistance. WHONET is an effective computerized microbiology laboratory data management and analysis program that can provide guidance for empiric therapy of infections, alert clinicians of trends of antimicrobial resistance, guide drug-policy decisions and preventive measures. The program facilitates sharing of data amongst different hospitals by putting each laboratory data into a common code and file format, which can be merged for national or global collaboration of antimicrobial resistance surveillance. The system can be implemented in hospital laboratories of Armed Forces at no additional cost. Cumulative analysis of surveillance data obtained from various hospitals of Armed Forces at higher centers may help in formulating health policies and control measures at various levels.