Pulmonary complications in intravenous drug users with and without human immunodeficiency virus co-infection

Abstract

Objective: to study features of pulmonary complications in intravenous drug users (IDUs) with and without HIV.

Materials and Methods: 149 patients (111 were males, mean age - 34,6±5,2 years)- IDUs diagnosed with pneumonia who were included in the study as they admitted to the hospital. HIV infection was verified in 112 (75%). 105 (70%) patients had viral hepatitis (B, C, B+C), 70 (47%) -tuberculosis.

Results: In the presence of HIV infection, especially with severe immunosuppression of CD4+ <30 cells/μl, clinical manifestations were febrile illness (89%), dyspnea (83%), pleuritic chest pain (68%), and symptoms of secondary diseases (candidiasis, lymphadenopathy, etc.). Chest CT showed multiple peripheral nodules in both lungs (n = 69), cavitation (n = 43), focal or wedge-shaped infiltrates (n = 38) and pleural effusion (n = 36). Methicillin-resistant Staphylococcus aureus (MRSA) (n = 34), methicillin-sensitive St. aureus (MSSA) (n = 22) and Candida (n = 16) has grown in blood cultures. HCV viremia was strongly related to HIV (OR, 6.262; 95% CI, 1.515-18.28), but negatively correlated to HBsAg seropositivity (OR, 0.161; 95% CI, 0.082-0.317). 41 patients died. In the absence of HIV in the clinical picture, bronchopulmonary manifestations were poorly expressed, the sepsis clinic prevailed.

Conclusion: pulmonary complications and secondary manifestations of HIV predominate in the clinic in HIV-infected IDUs. The current is characterized by an unfavorable prognosis. Appropriate antimicrobial therapy, control of the infectious source and resolution of the illness can be expected for most patients- IDUs with early diagnosis of pulmonary complications in the absence of HIV.