{"id":8340,"date":"2017-03-25T17:32:59","date_gmt":"2017-03-25T21:32:59","guid":{"rendered":"http:\/\/blogs.nejm.org\/hiv-id-observations\/?p=8340"},"modified":"2019-09-22T13:48:29","modified_gmt":"2019-09-22T17:48:29","slug":"hiv-and-hepatitis-c-are-no-longer-the-most-serious-infectious-threats-to-people-who-inject-drugs","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/hiv-and-hepatitis-c-are-no-longer-the-most-serious-infectious-threats-to-people-who-inject-drugs\/2017\/03\/25\/","title":{"rendered":"HIV and Hepatitis C Are No Longer the Most Serious Infectious Threats to People Who Inject Drugs"},"content":{"rendered":"

\"\"<\/a>I had dinner with\u00a0my daughter Mimi the other evening, and was ruminating about how things have changed since I started work\u00a0as an Infectious Diseases doctor around\u00a025 years ago.<\/p>\n

Here’s an excerpt of our chat:<\/p>\n

Me:<\/strong> \u00a0There are\u00a0way<\/em> more cases of endocarditis in young people than there used to be,\u00a0a complication of injecting drugs. People\u00a0in their 20s and 30s with life-threatening infections, getting admitted to the hospital, needing antibiotics for weeks, sometimes surgery … it’s awful. [I didn’t mean for this to sound like a cautionary speech\u00a0to my 21-year-old daughter, but reading it now — guilty as charged.]<\/em>
\nMimi:<\/strong> \u00a0Endocarditis?
\nMe:<\/strong> \u00a0Infection of the heart valves. It’s an incredibly serious problem, much more difficult to treat than HIV and HCV. Even with our best antibiotics, some people need\u00a0major heart surgery — their lives are never the same. And sometimes the infection spreads through the blood to the lungs, spine, brain… Some\u00a0even die!
\nMimi:<\/strong> \u00a0I’ve never even heard of it. And we never covered it in high school, and we had a ton<\/em> of drug talks\u00a0in health\u00a0classes. It was all HIV and hepatitis. And overdoses, of course.
\nMe:<\/strong> \u00a0Trust me, it’s a terrible problem.
\nMimi:<\/strong>\u00a0 I bet if I asked 10 of my smartest friends, most would be like, “What?” Hey,\u00a0I<\/em> can’t even remember what you called it, and you just told me. Here, let me check something. What’s the infection called again?
\nMe:<\/strong> \u00a0Endocarditis.
\nMimi<\/strong> [takes out her phone, does some rapid-fire tapping]: \u00a0Just did a Google search. “Endocarditis and injection drug use” has 179,000 hits, “HIV and injection drug use” has 1.6\u00a0million.<\/em>\u00a0And most of the endocarditis ones are in medical journals. Only doctors are going to read those.
\nMe:<\/strong> \u00a0How do we get the word out?
\nMimi:<\/strong> \u00a0It needs a better name. Something like\u00a0Zika<\/em>\u00a0— everyone can remember that.
\nMe:<\/strong> \u00a0Can I steal that line?
\nMimi:<\/strong> \u00a0Provided there’s proper attribution, go right ahead!<\/p>\n

For some context, Mimi is a\u00a0college junior and, while not medical school-bound, is a smart kid. (Of course<\/em> she is.) Having grown up with two doctor parents, she probably has a better than average fund of medical knowledge for her age.<\/p>\n

\"\"<\/a><\/p>\n

But the above conversation exposes a major gap in the lay public’s understanding of the risks of injection drug use — one hinted at\u00a0recently in a\u00a0piece on the clinical and ethical challenges of heart surgery<\/a> for people with addiction.<\/p>\n

For whatever reason, endocarditis and other invasive bacterial infections are not nearly as\u00a0feared as\u00a0HIV and HCV, despite the fact that the former are far more immediately life threatening and way<\/em> more difficult to treat.<\/p>\n

It’s true even among those who have had endocarditis. One woman told me that the most upsetting part\u00a0of her prolonged admission (complicated by cavitary lung lesions and spine\u00a0infection at multiple levels) was not the days of fevers, the pain when breathing, the severe back pain from the infection, back pain that still plagues her.<\/p>\n

It was when she found out\u00a0her hepatitis C test came back\u00a0positive.<\/p>\n

Let’s compare:<\/p>\n