- 1University of Massachusetts Medical School, Worcester, MA.
- 2Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA.
- 3Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA.
Background: Infective endocarditis (IE) is a life-threatening bacterial infection of the heart valves, most often diagnosed in older persons and persons with prior cardiac surgery. It is also associated with injection drug use, a behavior that has increased in recent years along with the U.S. opioid crisis.
Methods: We conducted a retrospective cohort analysis of commercial and Medicaid health insurance databases to estimate incident cases of IE in the United States in 2017, stratified by HIV, HCV infection and opioid use disorder (OUD). We also estimated annual percentage changes (EAPCs) in IE from 2007-2017 among persons with commercial insurance.
Results: The weighted incidence rate of IE was 13.8 cases per 100,000 persons among persons with commercial insurance, and 78.7 among those with Medicaid. The incidence rate of IE among commercially insured persons increased slightly from 2007-2017 (EAPC 1.0%). It decreased among commercially insured persons with HIV from 148.0 in 2007 to 112.1 in 2017 (EAPC -4.3%) and increased among those with HCV infection from 172.4 to 238.6 in 2017 (EAPC 3.2%). Among persons aged 18-29 years with HCV infection, IE increased from 337.6 in 2007 to 1028.7 in 2017 (EAPC 15.3%), and among those with OUD it increased from 156.4 in 2007 to 642.9 in 2017 (EAPC 13.8%).
Conclusions: The incidence rate of IE increased markedly among young persons with HCV infection or OUD. This increase appears to parallel the ongoing national opioid crisis. Harm reduction with syringe services programs, medications for opioid use disorder, and safe injection practices can prevent HIV, HCV, and IE.