title: A systematic review of injecting-related injury and disease among people who inject drugs.
abstract: Non-viral injecting-related injuries and diseases (IRID), such as abscesses and vascular damage, can result in significant morbidity and mortality if untreated. There has been no systematic assessment of the prevalence of non-viral IRID among people who inject drugs; this review aimed to address this gap, as well as identify risk factors for experience of specific IRID.
  
  
  
  We searched MEDLINE, Embase and CINAHL databases to identify studies on the prevalence of, or risk factors for, IRID directly linked to injecting in samples of people who inject illicit drugs.
  
  
  
  We included 33 studies: 29 reported IRID prevalence in people who inject drugs, and 17 provided data on IRID risk factors. Skin and soft tissue infections at injecting sites were the most commonly reported IRID, with wide variation in lifetime prevalence (6-69%). Female sex, more frequent injecting, and intramuscular and subcutaneous injecting appear to be associated with skin and soft tissue infections at injecting sites. Cleaning injecting sites was protective against skin infections. Other IRID included infective endocarditis (lifetime prevalence ranging from 0.5-12%); sepsis (2-10%); bone and joint infections (0.5-2%); and thrombosis and emboli (3-27%).
  
  
  
  There were significant gaps in the data, including a dearth of research on prevalence of IRID in low- and middle-income countries, and potential risk and protective factors for IRID. A consistent approach to measurement, including standardised definitions of IRID, is required for future research.
authors.affiliation: National Drug and Alcohol Research Centre, UNSW Australia, Sydney, Australia; Alpert Medical School, Brown University, Providence, RI, USA. Electronic address: s.larney@unsw.edu.au.
authors.forename: Sarah
authors.initials: S
authors.lastname: Larney
authors.affiliation: National Drug and Alcohol Research Centre, UNSW Australia, Sydney, Australia; School of Medicine, University of Tasmania, Hobart, TAS, Australia.
authors.forename: Amy
authors.initials: A
authors.lastname: Peacock
authors.affiliation: The Kirby Institute, UNSW Australia, Sydney, Australia.
authors.forename: Bradley M
authors.initials: BM
authors.lastname: Mathers
authors.affiliation: School of Social and Community Medicine, University of Bristol, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Hickman
authors.affiliation: National Drug and Alcohol Research Centre, UNSW Australia, Sydney, Australia; School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Global Health, School of Public Health, University of Washington, Seattle, WA, USA.
authors.forename: Louisa
authors.initials: L
authors.lastname: Degenhardt
mesh_terms: D005260:Female; D006801:Humans; D013287:Illicit Drugs / Q000009:adverse effects*; D007182:Income; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D018461:Soft Tissue Infections / Q000139:chemically induced / Q000453:epidemiology* / Q000517:prevention & control*; D015819:Substance Abuse, Intravenous / Q000453:epidemiology* / Q000517:prevention & control*
chemical_list: D013287:Illicit Drugs
keywords: Abscess; Endocarditis; Intravenous; People who inject drugs; Substance abuse