552. Injection Opiate Abuse and Blood Stream Infection in an Aging HIV-infected Veteran Cohort
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Active intravenous drug abuse (aIVDU) can increase susceptibility to blood stream infection (BSI) and allow exposure to HIV and other blood-borne viruses. Age may add another level of vulnerability in co-infected opiate-abusers. The potential added risk of age on the development of BSI in a HIV-infected cohort has not been previously investigated.
Methods: Computerized medical records of veterans in DC VAMC ID clinic (1/98-12/08) were reviewed retrospectively. The initial screen employed ICD-9 codes for opiate-abuse; followed by chart review to determine activity/mode of use (toxicology results, use of addiction services and provider-documented data). Episodes of BSI were documented; comparison analyses were performed including linear regression assessed the impact of age on BSI development/year of observation (SPSS v11.0).
Results: Among those with a coded-history of opiate-use in our clinic, 32% (138/437) were identified as aIVDU over the 11yr period. Hep C co-infection was present in 95% and 75% of aIVDU had an age greater than 50yrs. The mean rate of infection was 0.12 BSI/yrs-followed; 33(24%) pts had at least one BSI and, of those, 55% had >1 BSI. While mean rates for BSI were noted to be higher for the cohort <50 at study entry(0.15±0.43 vs 0.05±0.09, P=0.04), age at entry did not significantly impact BSI development over the time of observation(P=0.23). All-cause mortality was greater among those with BSI(64% vs 36%, P=0.005). Hospitalization was frequent and suspected inpatient line-manipulation was significantly associated with BSI(21.2% vs 4.8%, P=0.003).
Conclusion: The impact of IV drug-abuse on infectious complications is important to veteran health, including those with HIV. Despite high rates of mortality, hospitalization and hepatitis co-infection, a predominately elderly population of active-opiate users is followed in our clinic. Age did not confer additional risk to BSI, however in this elderly cohort, all-cause mortality was higher in those who developed at least one BSI in the study period.
Mark Delman, MD, VAMC, Washington, DC, Angelike P. Liappis, MD and  M. Delman, None..
A. P. Liappis, None.