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Type of submission: Oral
Conference track: Research
Topics: Creating Enabling Environments; Innovative Harm Reduction Programmes
Presenting author: Magdalena Harris
Magdalena Harris, Daniel Ciccarone, Vivian Hope, Jenny Scott
Background: A policy and research focus on blood-borne viruses among people who inject drugs (PWID) forecloses attention to other injecting related harms. One serious and neglected harm is AA amyloidosis: a multi-organ disease – leading to kidney failure – associated with persistent skin and soft tissue infections (SSTI) among PWID. Median survival from diagnosis is 19 months among PWID in the UK. With reports of injecting-related AA amyloidosis primarily limited to Nephology journals, awareness of this life-threatening condition is negligible in the Harm Reduction community.
Methods: We report findings from a review of evidence on AA amyloidodis among PWID. Databases (Medline, Scopus etc) were searched, with additional material generated through reference list searches and contact with practitioners. We also introduce the first mixed methods study to test the feasibility of AA amyloidosis screening among PWID and qualitatively explore barriers and facilitators to SSTI and AA amyloidosis care.
Findings: AA amyloidosis was first reported among PWID in the United States in 1978. Germany, Norway, US and the UK report increasing incidence of AA amyloidosis among PWID over the past decade, with indications that this is now the predominant cause of progressive renal disease among PWID. Dialysis adherence among PWID is poor and deaths from sepsis common. AA amyloidosis is preventable and potentially reversible. Disease progression can be arrested with early diagnosis, effective SSTI treatment and injecting cessation. AA-amyloidosis can be screened for, but this simple urinalysis test is not currently implemented in drug treatment services. Prevalence of AA amyloidosis among PWID is unknown.
Conclusion: AA-amyloidosis is a devastating yet preventable condition. Screening and prevention initiatives hold the potential to advert renal disease and save lives. Renewed attention to supporting non-injecting routes of administration coupled with non-stigmatising and innovative SSTI care interventions can help prevent AA amyloidosis and other serious SSTI selueqae.