Human Immunodeficiency Virus Infection and Infective Endocarditis among Injecting Drug Users

Abstract

Human immunodeficiency virus (HIV) infection and infective endocarditis are serious complications of injection drug use. To determine whether HIV infection may increase the risk of endocarditis beyond that associated with drug injection, we performed a nested case-control study among injecting drug users taking part in an ongoing cohort. We identified 26 participants with infective endocarditis between cohort enrollment (in 1988-1989) and June 1992, through reviews of medical records and death certificates. We matched each endocarditis case with up to five controls (N = 120) on enrollment date, race/ethnicity, and follow-up time. Data were taken from baseline and from the one follow-up visit: the last visit before the endocarditis occurred for cases and the closest visit (+/- 3 months) for controls. We used conditional logistic regression to quantify the association between HIV serostatus at follow-up and subsequent endocarditis, after adjusting for a history of endocarditis or sepsis before enrollment, injection duration, current injection frequency, and a recent history of abscess at injection sites. Among current injectors at follow-up, the adjusted odds ratio (OR) of developing endocarditis for HIV-seropositive subjects with > or = 350 CD4 cells per microliter, compared with HIV-seronegative subjects, was 2.31 [95% confidence interval (CI) = 0.61-8.78]; the corresponding OR for HIV-seropositive subjects with < 350 CD4 cells per microliter was 8.31 (95% CI = 1.23-56.37). These data indicate that HIV-related immunodeficiency may independently increase the risk of infective endocarditis among injecting drug users.

Influence of Human Immunodeficiency Virus 1 Infection and Degree of Immunosuppression in the Clinical Characteristics and Outcome of Infective Endocarditis in Intravenous Drug Users

“…However, some studies have shown that HIV infection is an independent risk factor for IE in IV drug users. 15,16 In our study population, multivariate analysis identified the following 4 variables as being independently associated with HIV infection: more than 5 years' use of IV drugs, right-sided IE, infection not due to S viridans, and white blood cell count at admission of no more than 10 ϫ 10 9 /L. The reason for the higher predominance of tricuspid valve involvement in HIVinfected IV drug users is not known.…”

Tricuspid valve endocarditis associated with intravenous nyoape use: A report of 3 cases

“…The OR increases to 8.31 at a CD4 + count of <350 cells/uL. [11] The mortality in patients with HIV and concomitant IE with a CD4 + count <200 cells/uL tends to be higher than in other groups. [12] More recent work, however, does not support the higher mortality in patients with low CD4 + counts.…”

HIV Specific Humoral Immune Response in Rio de Janeiro, Brazil

“…This group has a characteristically higher co-infection with organisms not generally associated with HIV infection, in addition to "traditional" opportunistic infections (Manoff et al 1996), while presenting a comparable median survival time after AIDS diagnosis to that observed in other exposure categories. However, these individuals may not be representative of the general population of IDUs, but should be assessed as "survivors" of HIV infection, considering the higher mortality of HIV infected IDUs not diagnosed as AIDS (Stoneburner et al 1988) or IDUs in general, due to a variety of non-HIVrelated causes, e.g.…”