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Bacterial infection of the heart on the rise among people with hepatitis C in United States

Keith Alcorn
23 June 2020

Diagnoses of infective endocarditis, a life-threatening bacterial infection of the heart valves, have become more common over the past ten years among people with hepatitis C and people with opioid use disorder in the United States, but cases fell among people living with HIV, a large study published in the journal Clinical Infectious Diseases shows.

Infective endocarditis is caused by bacteria entering the bloodstream, often through injecting drug use. Infective endocarditis can lead to heart failure or stroke and is a common cause of death in people who inject drugs.

To investigate the prevalence of infective endocarditis, investigators from the US Centers for Disease Control and Prevention looked at commercial and Medicaid public health insurance databases to find cases of infective endocarditis between 2007 and 2017. They used the databases to produce weighted incidence estimates based on the US population for each year from 2007 to 2017. The databases covered around 26 million people insured through employer insurance and around 20% of people who qualify for Medicaid, public insurance for people with low incomes, the elderly and people with disabilities.

They estimated an annual incidence of 13.1 cases per 100,000 persons in 2007 and 13.8 cases per 100,000 in 2017 in people with commercial insurance, a non-significant increase.

Cases increased in people with hepatitis C, from 172.4 per 100,000 in 2007 to 238.2 per 100,000 in 2017, an annual increase of 3.2%. Cases also increased in people with opioid use disorders, from 199.5 per 100,000 in 2007 to 357.1 per 100,000 in 2017, an annual increase of 5.7%. Cases also increased in young people aged 18-29 (6.6% per year) and in rural areas (2.7% per year).

“This increase appears to parallel the ongoing national opioid crisis,” the study authors wrote.

Cases declined in people with HIV, from 148 per 100,000 to 112 per 100,000, a 4.3% annual decline.

Infective endocarditis can be prevented by use of sterile injecting equipment and hand hygiene. Harm Reduction Coalition’s Getting Off Right Safety Manual explains harm reduction methods to reduce the risk of bacterial infection.

Harm reduction programmes that provide access to sterile injecting equipment including needles and syringes, cookers, filters and water, as well as alcohol swabs to clean the injection site and hand wash to minimise bacterial contamination can help to prevent bacterial endocarditis, the study authors say.

Harm reduction programmes that provide sterile injecting equipment also have the potential to provide treatment for minor bacterial skin infections and educate clients on prevention of bacterial infections.

Among healthcare providers, a diagnosis of infective endocarditis – or any bacterial skin infection – should prompt the offer of testing for HIV and hepatitis C, as well as discussion of substance use disorder treatment options including opioid substitution therapy, concluded authors of a previously published study also drawing on commercial insurance data. They found that only 8% of people who inject drugs in the US who presented for medical care were offered a test for hepatitis C between 2010 and 2017, and people receiving medical attention for bacterial skin infections or endocarditis were significantly less likely to be tested.