P-1825. Harm Reduction In US Veterans Who Inject Drugs: A Nationwide Cohort Study

Open Forum Infectious Diseases · 2026-01-01

Abstract Background Persons who inject drugs (PWID) are at increased risk for acquiring HIV, hepatitis C virus (HCV), and severe injection related infections (SIRI). There is sparse data about Veterans with a history of injection drug use (IDU) who access care through the Veterans Health Administration (VHA). This study aimed to identify a cohort of Veterans with evidence of IDU in order to assess clinical outcomes and harm reduction receipt.Table 1.Demographic characteristics of the cohort, stratified by OUD or StUD, with either HCV exposure or a SIRI.Table 2.IDU history, harm reduction uptake, and STI history among Veterans with either OUD or StUD and either HCV exposure or a SIRI. Methods A retrospective study was conducted of data obtained through the VHA Corporate Data Warehouse. Veterans who visited the VHA between 2016-2022 with an international classification of diseases, tenth edition (ICD-10) diagnosis of opioid use disorder (OUD) or stimulant use disorder (StUD), and a diagnosis of acute or chronic HCV or a SIRI were included. Cohort fidelity was assessed through a random sample of 560 Veterans. Active or remote IDU history was confirmed via text within the electronic health record. Demographics, rurality, census region, living and employment status, insurance, incarceration history, mental health and substance use histories were obtained. Harm reduction receipt was assessed.Table 3.HCV exposure or SIRI diagnoses in Veterans with either OUD or StUD who visited a VA facility between 2016 and 2022. Results There were 41,961 Veterans with OUD and HCV or a SIRI, and 46,936 Veterans with StUD and HCV or a SIRI. The OUD and StUD cohorts had a mean age of 62.2 and 61.4 years and was predominately male, White, and non-Hispanic. The highest census region was in the southern United States and in urban settings. HCV exposure was found in 28,505 (67.9%) Veterans with OUD and 33,707 (71.8%) Veterans with StUD. In the randomly selected cohort, 301 (53.8%) Veterans had a IDU history and 194 (34.6%) had active IDU. HCV exposure was found in 259 (86%) Veterans with a IDU history and 158 (81.4%) with active IDU. In Veterans with active IDU, 87 (55.1%) were treated for HCV or self-cleared, 114 (64%) were prescribed a medication for opioid use disorder (MOUD), and 147 (75.8%) were prescribed naloxone. Ten (5.2%) had a prior STI. Conclusion A significant proportion of Veterans with OUD or StUD have a history of IDU. Veterans with active IDU may benefit from expanded efforts to increase MOUD and naloxone uptake, STI testing, treatment and PrEP for HIV in conjunction with syringe services programs. HCV exposure has a strong concordance with a history of IDU. Disclosures All Authors: No reported disclosures

P-480. Improving HIV Screening Rates among US Veterans: A Quality Improvement Project

Open Forum Infectious Diseases · 2025-01-29

Abstract Background Fifteen percent of the 1.2 million people living with human immunodeficiency virus (HIV) in the United States are unaware of their infection, which increases risk of onward transmission and negative sequalae from untreated HIV. To improve early detection of HIV infection, the US Preventive Services Task Force recommends one-time HIV testing for all adults aged 15 to 65. The goal of this quality improvement project is to understand the rate of HIV testing in US Veterans (USV) who seek care at the Northport Veterans Affairs Medical Center (NVAMC) primary care setting and assess the efficacy of a quality improvement strategy to improve HIV screening rates.Table 1:HIV, HCV, and STI screening rates, and demographic variables identified in Veterans at NVAMC primary care setting.NVAMC, Northport Veterans Affairs Medical Center; HIV, Human Immunodeficiency Virus; HCV, Hepatitis C Virus; STI, Sexually Transmitted Infections; USV, United States Veterans Methods We conducted a prospective study of USV aged 15 to 65 from three Primary Care provider panels at NVAMC. Demographics, sexual history, injection drug use (IDU), prior hepatitis C virus (HCV), and sexually transmitted infection (STI) testing rates were obtained from chart review. USV without prior HIV screening were telephoned to obtain informed HIV testing consent and testing was ordered for USV who agreed. Results We identified 368 USV, with mean age of 60 years. The majority of this cohort were male (n=366, 99.4%) and White (n=262, 72.3%). Seventy-five (20.4%) USV did not have sexual orientation screening charted, no USV were identified as men who have sex with men (MSM), and 4 (1.1%) USV were identified with IDU history. Two hundred twenty (59.8%) USV had received prior HIV testing. Sixty-eight (18.5%) USV with no prior testing gave consent to obtain an HIV test, 29 (42.6%) USV underwent testing and 29 (100%) tested negative for HIV. Prior HCV testing was common (n=262, 71.2%); 2 (0.8%) USV had prior HCV infection and were treated. Sixty-two (16.8%) USV received testing for gonorrhea, 63 (17.1%) for chlamydia, and 138 (37.5%) for syphilis; one USV was identified with chlamydia infection history. We identified patient barriers to HIV testing (refusal, provider outside VA system) and provider factors (testing not offered). Conclusion Implementation of a telephone strategy improved HIV testing rates at NVAMC. HIV screening is cost effective as early identification improves survival due to linkage to care and access to treatment. Consequently, this may prevent forward transmission of HIV. Disclosures All Authors: No reported disclosures

Considerations when prescribing opioid agonist therapies for people living with HIV

Expert Review of Clinical Pharmacology · 2024-07-01 · 1 citations

INTRODUCTION: Medications for opioid use disorder (MOUD) include opioid agonist therapies (OAT) (buprenorphine and methadone), and opioid antagonists (extended-release naltrexone). All forms of MOUD improve opioid use disorder (OUD) and HIV outcomes. However, the integration of services for HIV and OUD remains inadequate. Persistent barriers to accessing MOUD underscore the immediate necessity of addressing pharmacoequity in the treatment of OUD in persons with HIV (PWH). AREAS COVERED: In this review article, we specifically focus on OAT among PWH, as it is the most commonly utilized form of MOUD. Specifically, we delineate the intersection of HIV and OUD services, emphasizing their integration into the United States Ending the HIV Epidemic (EHE) plan by offering comprehensive screening, testing, and treatment for both HIV and OUD. We identify potential drug interactions of OAT with antiretroviral therapy (ART), address disparities in OAT access, and present the practical benefits of long-acting formulations of buprenorphine, ART, and pre-exposure prophylaxis for improving HIV prevention and treatment and OUD management. EXPERT OPINION: Optimizing OUD outcomes in PWH necessitates careful attention to diagnosing OUD, initiating OUD treatment, and ensuring medication retention. Innovative approaches to healthcare delivery, such as mobile pharmacies, can integrate both OUD and HIV and reach underserved populations.

Assessment of harm reduction receipt and infectious diseases outcomes in United States Veterans with opioid use disorder and history of injection drug use

Harm Reduction Journal · 2024-11-27 · 1 citations

BACKGROUND: Injection drug use (IDU) may lead to negative health outcomes and increased healthcare utilization. In US Veterans (USV) with opioid use disorder (OUD), there is sparse information about healthcare utilization, harm reduction prescription, and outcomes associated with IDU, including severe injection-related infections (SIRI). We assessed psychosocial factors, clinical outcomes, and harm reduction receipt in a cohort of USV with OUD, specifically focusing on persons who inject drugs (PWID). METHODS: A retrospective cohort study was performed of USV aged ≥ 18 years with a diagnosis of OUD who presented to the Northport Veterans Affairs Medical Center (Long Island, NY) between 2012 and 2022. Demographics, psychosocial factors, history of human immunodeficiency virus (HIV), hepatitis C virus (HCV) infection, and healthcare utilization were compared by IDU status. Prescription of medications for opioid use disorder, naloxone and pre-exposure prophylaxis (PrEP) for HIV were also compared by IDU status. SIRI episodes and associated sequelae were characterized in USV with IDU. RESULTS: A total of 502 USV with OUD were included and 216 (43%) were PWID. Mean age was 52.6 years. PWID were more likely to use multiple stimulants (14.4% PWID vs. 7.3% non-PWID, p < 0.011), be hospitalized with an infection (26.4% PWID vs. 12.2% non-PWID, p < 0.001) and had more frequent inpatient admissions (n = 5.5 PWID vs. n = 3.51 non-PWID, p = 0.003). Among PWID, 134 (62%) had a history of HCV infection, 9 (4.2%) had HIV, and 35 (16.2%) had at least one SIRI episode. PWID had a higher frequency of current (51.9% PWID vs. 38.5% non-PWID, p = 0.003) or previous MOUD use (45.8% PWID vs. 31.1% non-PWID, p < 0.001). Overall PrEP receipt in our cohort (0.46% PWID vs. 1.4% non-PWID, p = 0.4) was low. CONCLUSIONS: USV with OUD and a history of IDU had a high prevalence of concurrent stimulant use, HCV, SIRI episodes, and were more likely to be hospitalized than USV with OUD and no history of IDU. Harm reduction strategies such as MOUD or PrEP, can help decrease the risk of infectious diseases, yet PrEP was underutilized in our population regardless of IDU status. USV with OUD would benefit from improved integration of OUD treatment, infectious diseases clinical care and harm reduction interventions.

HIV and Substance Use Disorders

Infectious Disease Clinics of North America · 2024-07-02 · 7 citations

2508. Evaluation of Infectious Diseases Complications in US Veterans with Opioid Use Disorder, a Single Site Experience

Open Forum Infectious Diseases · 2023

• Medicine
• Psychiatry
• Emergency medicine

Abstract Background Opioid use disorder (OUD) affects 2.7 million people in the United States and rates of OUD diagnosis are rising in US Veterans (USV). Injection drug use (IDU), including opioids, can lead to acquisition of bloodborne infections and severe injection related infections (SIRI). This study aims to describe infectious diseases epidemiology, substance use characteristics, and health care utilization in persons who inject drugs (PWID) and non-PWID with OUD who presented to the Northport Veterans Affairs Medical Center (NVAMC).Table 1.Demographic characteristics of USV with OUD, stratified by history of injection substance use. OUD, opioid use disorder. MOUD, medication for opioid use disorder. USV, US Veterans. PTSD, post-traumatic stress disorder. Methods Data was collected from a retrospective chart review of Veterans aged &amp;gt;18 years who had an ICD9 or ICD10 diagnosis of OUD and presented to the NVAMC between 2010-2020. Demographics, concomitant substance use and prior overdose histories, receipt of medications for opioid use disorder (MOUD), prior infection histories, hospitalizations, and emergency department (ED) visits were compared between PWID and non-PWID. Two-sample T-tests and Chi-square analyses were utilized. Results We identified 502 USV with a diagnosis of OUD. Mean age was 52.6 years, 469 (93.4%) were male, 396 (78.9%) were white, 172 (34.3%) were employed and 216 (43%) had health insurance. Post-traumatic stress disorder (n=275, 54.8%) was the most frequent psychiatric diagnosis and 216 (43%) USV had a history of IDU. PWID were more likely to have unstable housing (71.3% PWID vs 21.7% non-PWID, p&amp;lt; 0.001), be unemployed (60.2% PWID vs 43.7% non-PWID, p&amp;lt; 0.001), use cocaine (77.8% PWID vs 59.1% non PWID, p&amp;lt; 0.001), have a history of incarceration (49.1% PWID vs 38.5% non PWID, p=0.002), and have a prior overdose (53.7% PWID vs 27.3% non PWID, p&amp;lt; 0.001). Among PWID, 134 (62%) had hepatitis C virus and 30 (13.9%) had at least 1 SIRI, most frequently a skin and soft tissue infection (n=29, 13.4%). PWID were more likely to be hospitalized with an infection (26.4% PWID vs. 12.2% non PWID, p&amp;lt; 0.001) and had more inpatient admissions (5.5 PWID vs. 3.51 non PWID, p=0.003). ED visit frequency did not differ between groups.Table 2.Characteristics of SIRI and non SIRI among Veterans with OUD presenting to the Northport VAMC. SIRI, severe injection-related infection. OUD, opioid use disorder. SSTI, skin and skin structure infection. HBV, hepatitis B virus. HCV, hepatitis C virus. LOS, length of stay. Conclusion Veterans with OUD frequently present to the NVAMC with infections that require hospitalization. USV with OUD, especially PWID, would benefit from increased social support, as well as screening and treatment for OUD related infections. Disclosures All Authors: No reported disclosures

2679. Assessment of Sexually Transmitted Infection Incidence, Screening and HIV PrEP Uptake Among US Veterans with Opioid Use Disorder in Long Island, New York

Open Forum Infectious Diseases · 2023-11-27

Abstract Background Rates of sexually transmitted infections (STI) are on the rise in the US. Persons who inject drugs (PWID) and persons with opioid use disorder (OUD) are at an increased risk for acquisition of STI via high-risk sexual behavior concurrent with substance use. This study aims to compare rates of STI screening and diagnosis, hepatitis vaccination history, and receipt of HIV pre-exposure prophylaxis (PrEP) between PWID and non-PWID with OUD who presented to the Northport Veterans Affairs Medical Center (NVAMC). Methods Data was collected from a retrospective chart review of US Veterans (USV) aged &amp;gt;18 years who presented to the NVAMC between 2010-2020 and carried an ICD9 or ICD10 diagnosis of OUD. Rates of STI screening and diagnosis, hepatitis A (HAV) and B (HBV) vaccination status, and receipt of PrEP were compared between PWID and non-PWID using either a two-sample T-test or Chi-square analysis. Results We identified 502 USV with a diagnosis of OUD. Mean age was 52.6 years, 469 (92.4%) were male, 396 (78.9%) were white, 172 (34.8%) were employed and 216 (43%) had health insurance. A total of 337 (67.1%) USV had a history of cocaine use and 216 (43%) had a history of injection drug use. An STI was diagnosed in 51 (10%) USV, most frequently herpes simplex virus 1 or 2 (n=19, 3.8%), followed by syphilis (n=9, 1.8%). There was no difference in rates of STI between PWID and non-PWID USV. Eleven (2.2%) USV had HIV and 144 (28.7%) had HCV. A total of 411 (81.9%) USV received screening for HIV, 438 (87.3%) for HCV, 371 (74%) for syphilis, 160 (31.9%) for gonorrhea, and 169 (33.7%) for chlamydia. PWID were more likely to be screened for HIV (93.5% PWID vs. 73.1% non-PWID, p&amp;lt; 0.001), HCV (95.8% PWID vs. 80.8% non-PWID, p&amp;lt; 0.001) and syphilis (80.0% PWID vs. 69.2% non-PWID, p = 0.006) and to be vaccinated against HAV (73.6% PWID vs. 44.1% non-PWID, p&amp;lt; 0.001) and HBV (77.7% PWID vs. 54.3% non-PWID, p&amp;lt; 0.001). PrEP was prescribed in 4 (0.8%) USV.Table 2.STI screening rates and diagnoses among US Veterans with OUD, stratified by injection substance use. PWID, persons who inject drugs. STI, sexually transmitted infection. HAV, hepatitis A virus. HCV, hepatitis C virus. HSV, herpes simplex virus. PrEP, pre-exposure prophylaxis.Figure 1.Rates of STI Screening among PWID and non PWID with OUD who presented to Northport VAMC. STI, sexually transmitted infection. PWID, persons who inject drugs. OUD, opioid use disorder. Conclusion Among USV with OUD screening rates for gonorrhea and chlamydia occurred less frequently than for syphilis, HCV and HIV. PWID were more likely to be screened for HIV, HCV, and syphilis than non-PWID. There were low rates of PrEP uptake. USV with OUD may benefit from increased STI screening as well as linkage to PrEP evaluation and treatment. Disclosures All Authors: No reported disclosures

SARS-CoV-2 and Legionella Co-Infection

Journal of Global Infectious Diseases · 2023-01-01

Sir, The COVID-19 pandemic has caused a historic public health emergency, with an estimated 458 million confirmed cases and 6 million deaths.[1] The highly transmissible SARS-CoV-2 virus can cause severe pneumonia as well as extrapulmonary sequelae, making accurate diagnosis and management crucial.[2] Legionnaire’s disease is a severe atypical bacterial pneumonia that can be associated with SARS-CoV-2 infection.[3] Like SARS-CoV-2 infection, legionella may be associated with extrapulmonary symptoms, including diarrhea, hyponatremia, and neurological manifestations such as encephalopathy, among others.[4] Importantly, the mortality rate of legionella infection is high, with one study reporting over 6% mortality despite appropriate antibiotic therapy with either azithromycin or a fluoroquinolone.[5] A 74-year-old male presented to our institution with dyspnea, cough, and fever, found to be hypoxic with laboratory abnormalities including hyponatremia, hypophosphatemia, transaminitis, and acute kidney injury. Infectious work up detected SARS-CoV-2 RNA and a positive legionella urinary antigen. Chest x-ray was obtained demonstrating diffuse bilateral infiltrates [Figure 1]. He was treated with a 7-day course of azithromycin and symptoms as well as laboratory abnormalities resolved.Figure 1: High resolution chest X-ray from our patient with Legionella pneumonia demonstrating diffuse bilateral infiltratesWhile the COVID-19 pandemic continues to stress health-care systems worldwide, the presence of SARS-CoV-2 infection does not preclude the presence of other pneumonias. Multiple case reports have described SARS-CoV-2 and Legionella coinfection.[3,6,7] In 2 of 3 cases, a fever was documented. In addition, hyponatremia was seen in all three cases and an elevated white blood cell count and procalcitonin in 2 of 3 cases. These reports highlight the various overlapping signs and symptoms that make diagnosis challenging. The high mortality associated with both pneumonias necessitates a differential on the part of the healthcare provider to include bacterial superinfections in patients presenting with suspected or confirmed COVID-19 infection. Further, rapid diagnosis of bacterial pneumonia may allow for avoidance of COVID-19-specific therapy, such as dexamethasone or tocilizumab, which may affect viral clearance and alter recovery from bacterial pneumonia. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Corrigendum to ‘Maintenance on extended-release naltrexone is associated with reduced injection opioid use among justice-involved persons with opioid use disorder’ [J. Subst. Abuse Treat. vol. 142 (2022)/108852]

Journal of Substance Use and Addiction Treatment · 2023-06-03

1409. Infectious Complications in People Who Inject Drugs (PWID): A Retrospective Review and Recommendations for Improved Care

Open Forum Infectious Diseases · 2022-12-01

Abstract Background Suffolk County, NY is home to 1.5. million people and has a higher drug related deaths per capita rate compared to NY state average (19.9 vs 14.9/100,000). Injection drug use (IDU) is associated with complicated infections and inadequate treatment of substance use disorder (SUD) leads to relapse of infection and treatment failure. Unfortunately, access to SUD treatment services is not optimized in Suffolk County. We aimed to characterize the incidence and outcome of admissions for PWID and identify modifiable risk factors which can contribute to suboptimal care for PWID. Methods A retrospective review of SBUH electronic medical record was conducted from Jan 1, 2015 to June 1, 2021. Length of stay, discharge disposition, 6-month hospital readmission, insurance, employment and housing status, SUD history plus infection type and antimicrobial receipt were assessed. Results Of 425 patients (pts) admitted between Jan 1, 2015 to June 1, 2021, the median age was 34 years, 93% were white, and 59% male. Most pts. (89%) reported stable housing and had government insurance. The average length of stay was 13.6 days with 1/3 of pts. requiring ICU admission. Notably, 34% of pts left prematurely against medical advice and 34% were readmitted within 6 months. Formal ID (63%) and Psychiatry (62.5%) consults were not requested on all pts. Only 18% and 25% of pts. were treated with methadone or suboxone. 60% of screened pts. had HCV but 50% were not screened for co-infections. Complicated skin and soft tissue represented 70%, sepsis/bacteremia 11%, osteomyelitis/arthritis 10% and endocarditis 12% of the cases. 14.8% of pts. with endocarditis died, 48% had recurrent endocarditis, 52% needed surgery including 12% of repeat valve replacements. Staphylococcus species caused 42% of infections. About 2/3 of pts required continued antibiotic therapy at time of discharge, leading to delayed discharge for IV catheter placement. Conclusion Managing infectious complications in PWID is a multi-faceted endeavor extending beyond inpatient care. This study highlights the need for standardized treatment plans involving specialized case managers to reduce LOS and AMA discharges, improve screening for infections and integrate SUD treatment for PWID. Disclosures All Authors: No reported disclosures.