title: Seroprevalence of viral hepatitis and infectious complications among human immunodeficiency virus-infected injection drug users at a referral hospital.
abstract: OBJECTIVE
  The seroprevalence of viral hepatitis and spectrum of infectious complications among human immunodeficiency virus (HIV)-infected injection drug users (IDUs) remains unclear in Taiwan, although there has been a significant increase in the prevalence of HIV infection among IDUs in the last 2 to 3 years.
  
  
  METHODS
  The medical records of HIV-infected IDUs who sought medical care at a referral hospital for HIV care from June 1994 to December 2006 were retrospectively reviewed. A standardized case record form was used to collect demographic, clinical, laboratory and microbiologic data.
  
  
  RESULTS
  During the 12-year study period, a total of 102 HIV-infected IDUs with a median age of 39.5 years (range, 19 to 73 years) sought HIV care at the referral hospital. The male-to-female case ratio was 6 and males were significantly older than females (39.5 vs 28 years, p<0.001). The overall median CD4+ cell count and plasma HIV RNA load by reverse transcriptase-polymerase chain reaction at enrollment were 374 cells/microL and 4.45 log(10) copies/mL, respectively. The CD4+ cell count of HIV-infected IDUs enrolled after year 2003 was significantly higher than those enrolled before 2003 (438 vs 23 cells/microL, p<0.001). The seroprevalence of hepatitis C virus (86.6% overall) increased over time, while that of hepatitis B virus decreased in the patients born after 1984, when nationwide hepatitis B vaccination was started in Taiwan. Gram-positive bacteria were causative for 69.7% of the 33 bacteremic episodes, and Staphylococcus aureus was the leading pathogen (16 episodes), with methicillin-sensitive S. aureus accounting for 11 bacteremic episodes (33.3%). The most common bacterial infection was infective endocarditis. Tuberculosis occurred more frequently in men, and extrapulmonary tuberculosis was more common than pulmonary tuberculosis and was associated with a lower CD4+ count.
  
  
  CONCLUSIONS
  Bacteremia, infective endocarditis and tuberculosis were the three most common patterns of infection among HIV-infected IDUs who sought medical care at a referral hospital; and methicillin-sensitive S. aureus was the most common etiology of bacteremia. The high seroprevalence of hepatitis B and C and subsequent hepatic complications may present a future challenge to the health care system.
authors.affiliation: Section of Infectious Disease, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung County, Taiwan.
authors.forename: Shiou Haur
authors.initials: SH
authors.lastname: Liang
authors.forename: Yi-Chun
authors.initials: YC
authors.lastname: Lo
authors.forename: Hsi-Hsun
authors.initials: HH
authors.lastname: Lin
authors.forename: Sui-Yuan
authors.initials: SY
authors.lastname: Chang
authors.forename: Mao-Yuan
authors.initials: MY
authors.lastname: Chen
authors.forename: Szu-Min
authors.initials: SM
authors.lastname: Hsieh
authors.forename: Wang-Huei
authors.initials: WH
authors.lastname: Sheng
authors.forename: Hsin-Yun
authors.initials: HY
authors.lastname: Sun
authors.forename: Chien-Ching
authors.initials: CC
authors.lastname: Hung
authors.forename: Shan-Chwen
authors.initials: SC
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D004696:Endocarditis / Q000453:epidemiology; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology*; D015658:HIV Infections / Q000150:complications*; D006509:Hepatitis B / Q000453:epidemiology*; D006510:Hepatitis B Antibodies / Q000097:blood; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006526:Hepatitis C / Q000453:epidemiology*; D018937:Hepatitis C Antibodies / Q000097:blood; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood; D012189:Retrospective Studies; D016036:Seroepidemiologic Studies; D013211:Staphylococcus aureus / Q000302:isolation & purification; D015819:Substance Abuse, Intravenous; D013624:Taiwan; D014376:Tuberculosis / Q000453:epidemiology*; D019562:Viral Load
chemical_list: D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; D018937:Hepatitis C Antibodies; D012367:RNA, Viral