Clinical implications of addiction related immunosuppression

SummaryObjectivesDespite increasing evidence suggesting that drug addicts have compromised immunity, vigorous discussion continues. One way to examine this clinically is to compare the rates of infections presenting to a clinic which sees both non-substance dependent (N-SUD) and opiate addicted (SUD) patients.MethodsA survey was conducted amongst our patients of all infectious presentations.ResultsFour-hundred and thirty SUD and 116 N-SUD patients of similar ages (mean ± SD 30.81 ± 7.77 years vs. 32.91 ± 14.41 respectively) were reviewed. SUD had fewer acute infections (120/430, 28% vs. 51/116 44%, OR = 0.60 95% CI 0.40–0.84, P = 0.0034) but their severity was greater (P < 0.00001). The pattern of infections was also different with respiratory infections predominating in N-SUD (32/50 infections, 64%; seasonally invariant) vs. dental (74/114, 64%) and skin infections (18/114, 16%) in SUD. SUD had significantly more dental infections (74/430 patients 21% vs. 3/116 3%, P = 0.0001). In multivariate analysis, group membership was the only variable which explained the variance of “Infection”. Chronic hepatitis C (60% vs. 1%, P < 0.00001) was more frequent in the SUD but there was no difference in hepatitis B or HIV.ConclusionThese data are consistent with clinical immunosuppression in SUD and may reflect immunostimulation and immunosenescence.