Co-Morbidity of Infectious and Addictive Diseases in St. Petersburg and the Leningrad Region, Russia

Abstract

The Russian health care system is organized around specific diseases, with relatively little focus on integration across specialties to address co-morbidities. This organizational structure presents new challenges in the context of the recent epidemics of injection drug use (IDU) and HIV. This paper uses existing and new data to examine the prevalence of reported new cases of drug dependence (heroin) and HIV over time as well as associations between drug dependence and alcoholism, hepatitis B and C, and tuberculosis in the City of St. Petersburg and the Leningrad region. We found a sharp rise in reported cases of IDU beginning in 1991 and continuing until 2002/2003, followed by a sharp rise in newly reported cases of HIV. These rises were followed by a drop in new cases of HIV and drug addiction in 2002/2003 and a drop in the proportion of HIV-positve individuals with IDU as a risk factor. Infection with hepatitis B and C were common, especially among injection drug users (38 and 85%, respectively), but also in alcoholics (7 and 14%). Tuberculosis was more common in alcoholics (53%) than in persons with alcoholism and drug dependence (10%), or with drug dependence alone (4%). Though these data have many limitations, they clearly demonstrate that drug dependence and/or alcoholism, HIV, hepatitis, and tuberculosis frequently co-occur in St. Petersburg and the Leningrad Region. Prevention and treatment services across medical specialties should be integrated to address the wide range of issues that are associated with these co-morbidities.

Naltrexone with or without fluoxetine for preventing relapse to heroin addiction in St. Petersburg, Russia

“…The prevalence of HIV among heroin-dependent individuals dramatically increased during the last several years in the St. Petersburg/Leningrad Region such that more than 40% of opiate-addicted patients now seeking treatment are HIV-positive and injection heroin use is a major contributing factor (Krupitsky, Zvartau, & Karandashova, et al, 2004;Krupitsky et al, 2006;Krupitsky, Zvartau, & Masalov, et al, 2004). HIV drug risk was substantially reduced among patients who did not relapse and remained in treatment.…”

“…Injection heroin use increased markedly in Russia and other former Soviet states during the 1990s and was associated with a rapid spread of HIV and hepatitis (Krupitsky et al, 2006). This era also saw increases in patients seeking treatment for heroin addiction and hepatitis, and presented new challenges to the Russian health care system.…”

The changing epidemiology of hepatitis C virus infection in Europe

“…Indeed, with a few exceptions [140], HCV transmission among IDUs remains uncontrolled, with prevalence increasing among young IDUs, and incidence rates ranging between 11 and 42 per 100 person/years [120,132,141,142]. The worst situation is in Eastern Europe where the dramatic IDU-related HCV epidemic started in the early 1990s and harm reduction interventions remain limited [22][23][24]131,[143][144][145][146].…”

Sexually Transmitted Infections, Sexual Risk Behaviors and the Risk of Heterosexual Spread of HIV among and beyond IDUs in St. Petersburg, Russia

“…At the same time, Russia has experienced an increase in the prevalence of illicit drug use and in the levels of unprotected sexual activity among Russian youth and young adults [2][3][4] . This situation suggests a potential for HIV transmission from IDU to non-IDU partners [2,5] .…”