Hepatitis B induced fulminant liver failure: A call for prevention

Acute fulminant hepatic failure is a condition in which a healthy liver deteriorates rapidly following an insult, resulting in the impairment of its synthetic functions. This condition is rare and is associated with high fatality rates. We report the case of a 19-year-old male who was brought to the emergency room in an unconscious state with jaundice and persistent fever for 2–3 weeks after recently commencing intravenous use of morphine. He was found to be hepatitis B surface antigen reactive, and his laboratory tests indicated severe liver dysfunction with elevated levels of serum bilirubin, aspartate transaminase, alanine transaminase, gamma-glutamyl transferase, and International normalized ratio. The patient was diagnosed with fulminant liver failure with coagulopathy and hepatic encephalopathy. The patient’s family was addressed and counseled regarding the urgent need for liver transplantation. However, due to a lack of funds and insurance, supportive treatment was the only option left. Despite all supportive measures, the patient expired within 48 h. This case highlights the importance of various socioeconomic issues involved with liver transplantation, as in a resource-limited setting, urgent transplantation seems nearly impossible. In addition, this case report raises certain ethical issues that need consideration, particularly in an injection drug use scenario. It also highlights the importance of addressing the rising issue of injection drug use among youth, particularly in the regions of Punjab.

HIV-1 Transmission among Injecting Drug Users is Principally Derived from Local Circulating Strains in Guangxi, China / 生物医学与环境科学（英文）

OBJECTIVE@#The mode of human immunodeficiency virus (HIV) transmission via injection drug use (IDU) still exists, and the recent shift in IDU-related transmission of HIV infection is largely unknown. The purpose of this study was to analyze the spatiotemporal sources and dynamics of HIV-1 transmission through IDU in Guangxi.@*METHODS@#We performed a molecular epidemiological investigation of infections across Guangxi from 2009 to 2019. Phylogenetic and Bayesian time-geographic analyses of HIV-1 sequences were performed to confirm the characteristics of transmission between IDUs in combination with epidemiological data.@*RESULTS@#Among the 535 subjects, CRF08_BC (57.4%), CRF01_AE (28.4%), and CRF07_BC (10.7%) were the top 3 HIV strains; 72.6% of infections were linked to other provinces in the transmission network; 93.6% of sequence-transmitted strains were locally endemic, with the rest coming from other provinces, predominantly Guangdong and Yunnan; 92.1% of the HIV transmission among people who inject drugs tended to be transmitted between HIV-positive IDUs.@*CONCLUSION@#HIV recombinants were high diversity, and circulating local strains were the transmission sources among IDUs in Guangxi. However, there were still cases of IDUs linked to other provinces. Coverage of traditional prevention strategies should be expanded, and inter-provincial collaboration between Guangxi, Yunnan, and Guangdong provinces should be strengthened.

Correlates of perceived risk of HIV infection among persons who inject drugs in Tijuana, Baja California, Mexico / Correlaciones de percepción de riesgo de infección con VIH entre personas que se inyectan droga en Tijuana, Baja California, México

Objective. We identified correlates of perceived risk of HIV infection among persons who inject drugs (PWID) in Tijuana. Materials and methods. PWID ≥18 years of age who injected drugs in the past month were recruited between 2006-2007 and completed risk assessment interviews and serologic testing for HIV, syphilis, and tuberculosis. Logistic regression was used to determine factors associated with high-perceived risk of HIV infection. Results. Among 974 PWID, HIV prevalence was 4.4%; 45.0% of participants perceived themselves to be more likely to become HIV infected relative to other PWID in Tijuana. Participants who reported high-perceived risk of HIV infection participated in high-risk behaviors such as injecting with used syringes, transactional sex, and were less likely to have had an HIV test. Conclusions. Recognition of HIV infection risk was associated with high risk behaviors and markers of vulnerability. Findings support efforts to encourage HIV testing and access to health care for this vulnerable population.

Objetivo. Identificar factores correlacionados con el riesgo percibido de contraer VIH entre personas que se inyectan drogas (PID) en Tijuana. Material y métodos. Entre 2006-2007 se reclutaron PID ≥18 años de edad que se inyectaron drogas en el último año previo al estudio y completaron entrevistas para evaluación de riesgos y pruebas serológicas para VIH, sífilis y tuberculosis. Se utilizó regresión logística para determinar factores asociados con alto-riesgo percibido para la infección del VIH. Resultados. En los 974 PID la prevalencia de VIH fue 4.4%; 45.0% se consideró con mayor probabilidad de infectarse con VIH en relación con otros PID en Tijuana. Los participantes que reportaron alto riesgo percibido participaron en comportamientos de alto riesgo como inyectarse con jeringas usadas y transacción sexual, y tenían menos probabilidades de haber tenido una prueba de VIH. Conclusiones. Reconocer el riesgo del VIH se asoció con comportamientos de alto riesgo y marcadores de vulnerabilidad. Los resultados apoyan los esfuerzos para fomentar las pruebas para VIH y acceso a servicios de salud para esta población vulnerable.

A mimic of soft tissue infection: intra-arterial injection drug use producing hand swelling and digital ischemia / 世界急诊医学杂志（英文）

BACKGROUND: Inadvertent intra-arterial injection of illicit substances is a known complication of injection drug use and can lead to severe complications, including infection, ischemia and compartment syndrome. Identifying complications of intra-arterial injection can be difficult, as clinical manifestations overlap with other more common conditions such as cellulitis and soft tissue infection, and a history of injection drug use is frequently not disclosed. METHODS: A 37-year-old male patient presented with 24 hours of right hand pain, erythema and swelling. Despite classic "track marks", he denied a history of injection drug use, and vascular insults were not initially considered. After failing to respond to three days of aggressive treatment for suspected deep-space infection, an arteriogram demonstrated findings consistent with digital ischemia of embolic etiology. RESULTS: As a result of the delay in diagnosis, the lesion was not amenable to reperfusion and the patient required amputation of the distal digit. CONCLUSION: Practitioners should be alert to the possibility of intra-arterial injection and resulting complications when evaluating unusual extremity infections or unexplained ischemic symptoms, even in the absence of a definite history of injection drug use.

Hepatitis C in hemodialysis: the contribution of injection drug use

BACKGROUND: Hepatitis C virus (HCV) infection is the most common cause of acute or chronic hepatitis in patients on hemodialysis (HD). The purpose of this study was to describe the prevalence of positive HCV RNA and investigate injection drug use as an emerging risk factor in patients with chronic renal disease on HD. METHODS: This was a multicenter cross-sectional study with 325 patients with chronic renal disease on HD in the period between August 1, 2005 to August 30, 2006, receiving care at four institutions in the city of Porto Alegre, Southern Brazil. Epidemiological data were collected by means of a structured questionnaire. The following laboratory tests were performed: alanine aminotransferase (ALT), anti-hepatitis C virus antibodies (anti-HCV), and qualitative polymerase chain reaction (PCR). RESULTS: Of 325 patients, 68 had positive HCV RNA results. The comparison between patients with positive and negative PCR results revealed significant differences in duration of HD (mean = 71 versus 52.4 months; p = 0.02); previous blood transfusion (92 percent versus 72 percent; p < 0.01); injection drug use (13 percent versus 0.7 percent; p < 0.01); anti-HCV positivity at start of HD therapy (60 percent versus 4 percent; p < 0.01); and mean ALT value (39 versus 26.5; p < 0.01). Logistic regression analysis showed a positive HCV RNA independently associated to being on HD for more than five years [OR: 2.1 (95 percent CI 1.2 -3.8)]; previous blood transfusion [OR: 3.7 (95 percent CI 1.4 - 9.5)]; and injection drug use [OR: 22.6 (95 percent CI 4.2 - 119.6)]. CONCLUSION: Injection drug use was an independent risk factor for HCV infection among chronic renal disease patients on HD.

Harm Reduction and Injection Drug Use: In the Era of HIV/AIDS / 国際保健医療

This article presents harm reduction, which was recently developed in response to the expansion of injection drug use and the HIV/AIDS epidemic. The authors describe the essence of harm reduction, proposing that harm reduction is a pragmatic strategy from a public health perspective to deal with injection drug use. Also, how harm reduction complements the traditional strategies to eradicate illicit drug use based on abstinence (so called, War on Drugs, or Just Say NO) is discussed. By describing key principles of harm reduction, such as low-threshold programs, non-judgmental attitudes, priority of immediate goals, and balancing costs and benefits, the authors introduce major harm reduction programs, which include needle/syringe exchange, outreach, counseling and education, supervised injection sites, and substitution treatment. Substantial evidence demonstrates harm reduction is effective in preventing the spread of HIV. Although international bodies, such as UNAIDS and WHO, advocate harm reduction strategies for the better prevention from the spread of HIV/AIDS, and some countries have adopted national harm reduction policies, United States discourages harm reduction policies in fighting the global HIV/AIDS pandemic. Finally, the authors address the effectiveness of harm reduction from the public health perspectives to deal with AIDS epidemic among injection drug users and the necessity of comprehensive understanding and multifaceted application of harm reduction. They also present the need to rethink Japanese government policies and social programs to meet drug users' health needs.