CHALLENGES AND PARTICULARITIES IN THE MANAGEMENT OF SEVERE BACTERIAL INFECTIONS IN HIV-INFECTED INJECTING DRUG USERS

Injecting drug use became during last decade a major health public issue, both in Romania and around the world. Incidence of HIV and viral hepatitis in injecting drug users (IDUs) has dramatically increased due to the appearance of new highly addictive drugs (called “ethnobotanicals”) with unknown effects and associated with increased use of unsterile injecting equipment. Severe bacterial infections with poor outcome often complicate the clinical evolution of these patients, especially in case of severe immunosuppression secondary to HIV. We will describe in this review the most common bacterial infections developed due to injecting drug use. Bacterial endocarditis in IDUs are usually right-sided, Staphylococcus aureus being the most common pathogen. These patients also develop skin/soft tissues and respiratory tract infections (due to altered local defense mechanisms), as well as sexually transmitted diseases due to high risk sexual behavior, usually determined by recreational drug use. This behavior is known as “ChemSEX” and is usually practiced by men having sex with men. There were also reported cases of wound botulism, tetanus and even anthrax epidemics among IDUs. HIV infected IDUs usually require complex management with multidisciplinary approach and sometimes surgical treatment