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Patterns of Infectious Disease Associated With Injection Drug Use in Massachusetts.

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Rising hepatitis C virus (HCV) cases may precede outbreaks of human immunodeficiency virus (HIV) among people who inject drugs. This highlights the need for careful screening for substance use disorder and associated infections.

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Area of Science:

  • Epidemiology
  • Infectious Diseases
  • Public Health

Background:

  • Since 2014, the US has faced converging public health crises involving outbreaks of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) among people who inject drugs.
  • These outbreaks are often accompanied by skin and soft tissue infections (SSTIs) and infective endocarditis (IE).

Purpose of the Study:

  • To analyze the temporal relationships between infectious diseases and overdose events.
  • To understand the patterns that may precede outbreaks of HIV among people who inject drugs.

Main Methods:

  • A hierarchical Bayesian distributed lag logistic regression model was employed.
  • The model examined the probability of at least one HIV case per month based on lagged counts of overdose, HCV, SSTI, and IE.

Main Results:

  • Increased hepatitis C virus (HCV) cases occurring 5 and 7 months prior were associated with a 4% increase in the odds of observing a current-month HIV case.
  • Abscess incision and drainage procedures and skin and soft tissue infection (SSTI) cases also showed distinct temporal associations with current-month HIV.
  • No significant associations were found between echocardiograms, infective endocarditis (IE), or overdose rates and current-month HIV cases.

Conclusions:

  • Lagged associations of preceding infections may indicate emerging epidemics of injection drug use and related conditions.
  • These findings suggest clinicians should enhance screening for substance use disorder and associated infections.
  • The observed patterns are not predictive of HIV outbreaks but offer insights into disease dynamics.