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Personer som injicerar droger har en hög förekomst av infektionssjukdomar. Bakteriella agens orsakar lokala hudinfektioner och systemiska tillstånd med efterföljande komplikationer som endokardit och osteoartikulära infektioner. Spridning av blodsmittor, som hiv och hepatit B och C, är vanligt förekommande. Hepatit C-virusspridningen i Sverige är störst bland personer som injicerar droger. Diagnos, behandling och tillgång till skadereducerande insatser behövs för att minska smittspridning bland personer som injicerar droger. Samverkan mellan olika vårdinstanser och socialtjänst kan behövas för att personer som injicerar droger ska kunna etablera och upprätthålla kontakt med vården.

People who inject drugs (PWID) have a high prevalence of bacterial and viral communicable diseases. Bacterial skin and soft tissue infections, sepsis, infective endocarditis and bone and joint infections as well as blood-borne viruses (HIV, hepatitis B and C) are commonly associated with injection drug use. In this article we provide an overview of these infectious diseases among PWID and provide practical information regarding diagnosis, prevention and treatment. Sweden has formulated a national viral hepatitis plan identifying PWID as a specific risk group for hepatitis C. Targeted preventive and therapeutic measures, including needle and syringe programs, for PWID are crucial for overall reduction of hepatitis C infections in Sweden. We emphasize the importance of collaboration between healthcare providers and social services to minimize the spread of infections through preventive measures and prompt treatment.

Purpose: COVID-19 has been extensively researched; however, the lack of standardized COVID-19 severity categorization in register-based research complicates comparison of studies. The WHO COVID-19 Clinical Progression Scale is a standardized disease severity tool for clinical data, though not adapted to data available in health registries. We aimed to develop and validate such a novel categorization with international applicability.

Methods: The WHO Clinical Progression Scale was translated to a severity index utilizing ICD-and procedure-codes from outpatient, inpatient, intensive care, and mortality registries using the adult Swedish population and SARS-CoV-2 positive-test data (January 2020 – July 2022). Cox proportional hazards were applied to determine whether increasing severity correlates with mortality in COVID-19 patients compared to the population.

Results: The WHO-Scale was translated to ten categories reflecting the increasing need for advanced care, encompassing 8,245,474 individuals including 1,981,946 SARS-CoV-2 infections. Fatal COVID-19 cases were older with more comorbidities. Those receiving mechanical ventilation and ECMO were younger with fewer comorbidities. Among survivors beyond 30 days, 90-day all-cause mortality increased with severity using category zero (no laboratory-verified SARS-CoV-2) as reference. Mortality was lowest for patients without health care adjusted for age, sex, comorbidities and socio-economic variables (adjusted hazard ratio (aHR) 1.18, 95% confidence interval (CI) 1.13–1.22). Those hospitalized >5 days had higher mortality (aHR 5.83, 5.5–6.17). Those requiring ECMO/ ECLS had the highest mortality (aHR 593.54, 317.77–1108.65).

Conclusion: The novel COVID-19 severity index associated with all-cause 90-day mortality and aligned with previous literature. This index will enable comparative studies of COVID-19, which is important for public health policies and development of clinical guidelines. This is an innovative epidemiologic tool with potential applicability in all countries with centralised health registers. The index also has the potential to be used for other infectious diseases and in real-time data for modelling predictions.

PURPOSE: Individuals with severe liver disease are more vulnerable to severe COVID-19, but the association between chronic hepatitis B virus (HBV) infection and severe COVID-19 remains unclear. This study evaluates this relationship.

METHODS: We analysed nationwide Swedish data from national databases and healthcare registers, identifying laboratory-confirmed COVID-19 cases from February 2020 to April 2021. Chronic HBV infection was classified into cases with and without cirrhosis. Multivariable logistic regression assessed the association between HBV and severe COVID-19, adjusting for demographics, comorbidities, vaccination, and socioeconomic factors.

RESULTS: Among 1,057,174 COVID-19 cases, 2,902 had chronic HBV infection, which was associated with increased risk of severe COVID-19 (adjusted odds ratio [aOR] 1.242, 95% confidence interval [CI] 1.097-1.403). This risk was significantly higher in HBV individuals with cirrhosis (aOR 2.463, CI 1.546-3.892) compared to those without cirrhosis (aOR 1.183, CI 1.039-1.343). While overall COVID-19 mortality was not significantly elevated in the HBV cohort, patients with cirrhosis showed a higher, though nonsignificant, mortality risk (aOR 2.350, CI 0.921-5.203).

CONCLUSION: This nationwide study highlights an increased risk of severe COVID-19 in individuals with chronic HBV, particularly those with cirrhosis. Geographic and socioeconomic factors further influence outcomes. These findings underscore the need to consider HBV status in COVID-19 risk assessments. Future studies should explore these associations in the context of evolving SARS-CoV-2 variants and widespread vaccination.