Infective Endocarditis Among Persons Aged 18–64 Years Living with Human Immunodeficiency Virus, Hepatitis C Infection, or Opioid Use Disorder, United States, 2007−2017

Abstract

Background Infective endocarditis (IE) is a life-threatening bacterial infection of the heart valves, most often diagnosed in older persons and persons with prior cardiac surgery. It is also associated with injection drug use, a behavior that has increased in recent years along with the US opioid crisis. Methods We conducted a retrospective cohort analysis of commercial and Medicaid health insurance databases to estimate incident cases of IE in the United States in 2017, stratified by persons living with human immunodeficiency virus (HIV), hepatitis C virus (HCV), and opioid use disorder (OUD). We also estimated annual percentage changes (EAPCs) in IE from 2007–2017 among persons with commercial insurance. Results The weighted incidence rate of IE was 13.8 cases per 100 000 persons among persons with commercial insurance, and 78.7 among those with Medicaid. The incidence rate of IE among commercially insured persons increased slightly from 2007–2017 (EAPC, 1.0%). It decreased among commercially insured persons living with HIV, from 148.0 in 2007 to 112.1 in 2017 (EAPC, −4.3%), and increased among those with HCV infection, from 172.4 in 2007 to 238.6 in 2017 (EAPC, 3.2%). Among persons aged 18–29 years with HCV infection, IE increased from 322.3 in 2007 to 1007.1 in 2017 (EAPC, 16.3%), and among those with OUD it increased from 156.4 in 2007 to 642.9 in 2017 (EAPC, 14.8%). Conclusions The incidence rate of IE increased markedly among young persons with HCV infections or OUD. This increase appears to parallel the ongoing national opioid crisis. Harm reduction with syringe services programs, medications for opioid use disorder, and safe injection practices can prevent the spread of HIV, HCV, and IE.

Harm reduction for the treatment of patients with severe injection-related infections: description of the Jackson SIRI Team

“…However, infections due to injection drug use (IDU) have not garnered the same level of policy or research attention compared to drug overdose deaths [ 3 , 4 ]. In the United States, incidence rates of opioid use disorder (OUD)-associated endocarditis increased by nearly 80% between 2007 and 2017 [ 5 ]. Hospitalizations for SIRIs, which include skin and soft tissue infections (SSTI), bacteraemia, endocarditis, osteomyelitis, and septic arthritis, are characterized by long lengths of stay [ 6 ], high readmission rates [ 7 ], frequent patient-directed discharge (also known as “against medical advice”) [ 6 ], and post-discharge mortality [ 8 ].…”

Using Positive Empathy Interventions to Reduce Stigma Toward People Who Inject Drugs

“…Opioid use has increased substantially in the United States over the past decade, initially fueled by misuse of prescription opioids and more recently sustained by the use of heroin and fentanyl. Concurrent with this increase in opioid use, the United States has seen alarming increases in drugrelated mortality and morbidities related to injection drug use including overdose fatalities, viral hepatitis, HIV, and serious injection-related bacterial infections like endocarditis (Zibbell et al, 2015;Hedegaard et al, 2020;Wong et al, 2020). There are effective medical treatments for opioid use disorder, as well as effective public health interventions to reduce overdose mortality and injection-related infections.…”

Injections and infections: understanding syringe service program utilization in a rural state

“…The increasing prevalence of substance use disorders in the United States has highlighted the need to examine approaches to reduce injection drug use (IDU)-associated infections [ 24 ]. Unsafe injection practices among people who inject drugs (PWID) have led to rising rates of HIV, viral hepatitis, and serious bacterial and fungal infections, such as infective endocarditis [ 10 , 22 , 31 , 32 ]. From 2014 to 2018, new HIV diagnoses among PWID in the United States increased by 9% [ 21 ] and acute hepatitis C also increased, particularly among people ages 20–39 years old.…”

“…The number of estimated acute hepatitis C cases in 2018 was 50,300, compared to 17,100 in 2011, with 72% of reported cases attributable to IDU [ 19 ]. In a recent study using national commercial and Medicaid databases, the incidence of infective endocarditis among people with opioid use disorder increased from 156.4/100,000 to 642.9/100,000 in 2017 [ 31 ]. Harm reduction services, specifically syringe services programs (SSPs), have been shown to effectively counsel clients about safe injection techniques, reduce the transmission of infections like HIV, deliver overdose prevention/education, administer vaccinations, and also facilitate referrals for medication for opioid use disorder (MOUD) [ 7 , 8 , 16 ].…”