Post-its from Practice:
Never forget HIV amongst injecting drug users (Nov 2006)
Matthew registered with us so he could have his blood tests before going into rehabilitation. We knew that the local community drug team (CDT) was providing him with a methadone script and monitoring his Hepatitis C infection. However, as he was also a heavy drinker, he had not been offered any further intervention.
We discussed with him what tests might be worth doing and he agreed willingly to have a HIV test among others, although he thought a positive result unlikely as he was under both the CDT and the hospital Hepatitis C clinic. Despite this, I gave the usual pre-test discussion before taking his blood for Hepatitis A, B and C, HIV, as well as LFTs, FBC etc. (Ref 1). We were both surprised to find his HIV test was positive and even more surprised with his CD4 count of 290, suggesting that he had probably been positive for several years.
How could this be? He has been in both community and hospital care for over 20 years. Have we have forgotten HIV in drug users? We do so at their peril.
'Shooting Up' (Ref 2), a report recently released by the Health Protection Agency shows that there has been an increase in HIV among injecting drug users. Today, 1:50 Injecting Drug Users (IDUs) in the UK are infected with HIV. This is around twice the level seen at the beginning of the decade. In particular, the HIV prevalence has been rising since 2002 among those who have been injecting for less than three years (Ref 3). Increasing evidence suggests that injecting crack cocaine is a major factor (Ref 4).
The report also found that while levels of HIV remain high among current IDUs in London, with around one in 25 infected, the recent increase in the number of cases has been greatest outside of London (data relating only to England and Wales) where it has risen from approximately 1:400 in 2003 to about 1:65 in 2005.
Elevated levels of reported needle and syringe sharing have been seen since the late 1990s, with around 3:10 IDUs currently reporting this. The underlying factors for these differences are not clear, but they are a cause for concern.
Matthew reacted to the diagnosis with commendable insight. He informed his parents and his kids of the result and explained that treatment was available. We have an excellent HIV service down the road and he is about to start treatment less than 2 months after his diagnosis.
So my plea to you all is to regularly screen all people who use drugs whether they are in drug treatment or not for HIV and Hepatitis, to provide sufficient injecting equipment so that people don't have to share and to never forget HIV infection - it hasn't gone away.
2. Health Protection Agency, Health Protection Scotland, National Public Health Service for Wales, CDSC Northern Ireland, CRDHB, and the UASSG. Shooting Up: Infections among injecting drug users in the United Kingdom 2005. London: Health Protection Agency, October 2006. ISBN 0 901144 86 X
3. Hope VD, Judd A, Hickman M, Sutton A, Stimson GV, Parry JV et al. HIV prevalence among Injecting Drug Users in England and Wales 1990 to 2003: Evidence for increased transmission in recent years. AIDS 2005; 19: 1207-14.
4. Hope VD, Hickman M, Tilling K. Capturing crack-cocaine use: Estimating the prevalence of crack-cocaine use in London using capture-recapture with covariates. Addiction, 2005; 100: 1701-8.