Influence of Human Immunodeficiency Virus 1 Infection and Degree of Immunosuppression in the Clinical Characteristics and Outcome of Infective Endocarditis in Intravenous Drug Users

Ribera, Esteban; Miró, José M.; Cortés, Emilia Barrot; Cruceta, Ana; Mercé, Jordi; Marco, Francesc; Planes, Ana María; Jc, Paré; Moreno, Asunción; Ocaña, Imma; Gatell, José M.; Pahissa, Albert

doi:10.1001/archinte.158.18.2043

Cited by 68 publications

(46 citation statements)

References 20 publications

(29 reference statements)

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“…In addition, some subjects with prior P. carinii pneumonia died early after ICU discharge, as a consequence of other AIDS-related problems, con®rming the defective immunological status of this population. Similarly, ICU survival was related to the degree of immunosuppression in the patients with bacterial pneumonia, an observation that has also been reported in HIV patients with infective endocarditis [35].…”

Section: Discussionsupporting

confidence: 63%

Reappraisal of the aetiology and prognostic factors of severe acute respiratory failure in HIV patients

Alves

Nicolás²,

Miró³

et al. 2001

Eur Respir J

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The introduction of highly active antiretroviral therapy with protease inhibitors in 1996 has changed the morbidity and mortality of acquired immune deficiency syndrome patients. Therefore, the aetiologies and prognostic factors of human immunodeficiency virus (HIV)-infected patients with life-threatening respiratory failure requiring intensive care unit (ICU) admission need to be reassessed.From 1993 to 1998, we prospectively evaluated 57 HIV patients (mean±sem age 36.5±1.3 yrs) admitted to the ICU showing pulmonary infiltrates and acute respiratory failure.A total of 21 and 30 patients were diagnosed as havingPneumocystis cariniiand bacterial pneumonia, respectively, of whom 13 and eight died during their ICU stay (p=0.01). Both groups of patients had similar age, Acute Physiology and Chronic Health Evaluation (APACHE) II score, and severity in respiratory failure. The number of cases with bacterial pneumonia admitted to ICU decreased after 1996 (p=0.05). Logistic regression analysis showed that (APACHE) II score >17, serum albumin level <25 g·L−1, and diagnosis ofP. cariniipneumonia were the only factors at entry associated with ICU mortality (p=0.02).Patients with bacterial pneumonia are less frequently admitted to the intensive care unit after the introduction of highly active antiretroviral therapy with protease inhibitors in 1996. Compared to the previous series, it was observed that the fewPneumocystis cariniipneumonia patients that need intensive care still have a bad prognosis.

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Section: Discussionsupporting

confidence: 63%

Reappraisal of the aetiology and prognostic factors of severe acute respiratory failure in HIV patients

Alves

Nicolás²,

Miró³

et al. 2001

Eur Respir J

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“…17 Opioid users are highly susceptible to a variety of infections. Such common infections include HIV, viral hepatitis 18,19 and infective endocarditis, 20 all of which have significance in a dental setting. This increased propensity towards infection can be attributed to the sharing of contaminated needles, an increased participation in unsafe sexual activity and a reduced immune competence.…”

Section: Medical Problemsmentioning

confidence: 99%

“…The significance of immunosuppression in these patients is clearly demonstrated by the fact that opioid users can contract infective endocarditis on a previously uncompromised endocardium. 20 Although factors associated with drug use, such as alcoholism, 8 dietary deficiency 21 and general personal neglect can all adversely affect the immune system, there is a growing body of evidence that certain opioid drugs are capable of directly suppressing aspects of immunity. Such direct opioid effects on immune function include a lowering of the total lymphocyte count, a depression in the CD4:CD8 lymphocyte ratio, a reduction in immunoglobulin and tumour necrosis factor production and suppression of natural killer (NK) cell activity.…”

Section: Medical Problemsmentioning

confidence: 99%

Impact of Opioid Use on Dentistry

Ferguson

2002

Australian Dental Journal

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The oral consequences of opioid drug use are commonly attributed to personal neglect of general health and financial constraint. These factors are compounded by the increasingly recognized range of physical effects exerted by opioid drugs. The dental management of opioid drug dependents is further complicated by a variety of infections and behavioural modifications commonly associated with opioid use. Adequate strategies for the oral care of opioid users need to take cognisance of the broad medical issues for these people along with an appropriate personal approach.

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“…In a 10-year prospective study of IDUs, the incidence of IE was higher among HIV-positive than HIV-negative users and the disease was more common in patients with advanced immunosuppression, even after accounting for injection drug use behaviours [12]. Patients with symptomatic HIV infection and severe immunosuppression are more likely to die from IE [10,[12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Infective Endocarditis in Intravenous Drug Users from Italy: the Increasing Importance in HIV-infected Patients

et al. 2007

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Infective endocarditis in IDUs is significantly associated with right-side localization (63.5% for any rightsided heart involvement vs 43.7% for any left-sided heart involvement; OR 2.24; 95% CI 1.55-3.23; p < 0.001). S. aureus is the microorganism most frequently isolated and is significantly associated with TV involvement. Any left-side involvement and age greater than 35 years are independently associated with mortality. HIV infection does not appear to have a significant effect on mortality.

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Influence of Human Immunodeficiency Virus 1 Infection and Degree of Immunosuppression in the Clinical Characteristics and Outcome of Infective Endocarditis in Intravenous Drug Users

Cited by 68 publications

References 20 publications

Reappraisal of the aetiology and prognostic factors of severe acute respiratory failure in HIV patients

Reappraisal of the aetiology and prognostic factors of severe acute respiratory failure in HIV patients

Impact of Opioid Use on Dentistry

Infective Endocarditis in Intravenous Drug Users from Italy: the Increasing Importance in HIV-infected Patients

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