What happened to the HIV epidemic among non-injecting drug users in New York City?
What happened to the HIV epidemic among non-injecting drug users in New York City?
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DOI：
10.1111/add.13601
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发表时间：
2017-02
期刊：
影响因子：
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通讯作者：
Perlman DC
中科院分区：
文献类型：
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作者：
Des Jarlais DC;Arasteh K;McKnight C;Feelemyer J;Campbell AN;Tross S;Cooper HL;Hagan H;Perlman DC
艾滋病毒在许多非注射毒品使用者人群中的流行率很高。本研究的目的是1）检查纽约市非注射可卡因和海洛因NIDUs中艾滋病毒流行的趋势，2）确定与趋势潜在相关的因素，3）估计NIDUs中艾滋病毒的发病率。对参加戒毒治疗方案人员的系列横断面调查。每个人每年只能参加一次，但可以参加多年。美国纽约市西奈山贝斯以色列戒毒项目。从2005年到2014年，我们招募了3298名非注射可卡因和海洛因使用者。参与者78%为男性，6%为白色，26%为西班牙裔，66%为非洲裔美国人。吸食快克可卡因是最常见的非注射毒品做法。趋势检验被用来检查艾滋病毒的流行率，人口统计学，药物使用，性行为和使用抗逆转录病毒治疗（ART）的日历年。卡方和多变量logistic回归用于比较2005 - 2010年与2011 - 2014年。艾滋病毒流行率每年下降约1%（p < 0.001），从2005 - 2010年的16%下降到2011- 2014年的8%（p < 0.001）。吸烟和有多个性伴侣的参与者比例下降，接受抗逆转录病毒治疗的艾滋病毒阳性者比例增加。重复参与者的HIV发病率为1.2/1000人-年（95% CI 0.03/1000 - 7/1000）。艾滋病毒流行率有所下降，艾滋病毒呈阳性的非注射吸毒者接受抗逆转录病毒治疗的比例很高，这表明艾滋病毒在纽约市非注射吸毒者中的流行已经结束。这些结果可被视为一种概念证明，即有可能控制与非注射吸毒有关的性传播艾滋病毒流行病。
HIV has reached high prevalence in many non-injecting drug user (NIDU) populations. Aims of this study were to 1) examine the trend in HIV prevalence among non-injecting cocaine and heroin NIDUs in New York City, 2) identify factors potentially associated with the trend, 3) estimate HIV incidence among NIDUs. Serial-cross sectional surveys of persons entering drug treatment programs. Persons were permitted to participate only once per year, but could participate in multiple years. Mount Sinai Beth Israel drug treatment programs in New York City, USA. We recruited 3298 non-injecting cocaine and heroin users from 2005 to 2014. Participants were 78% male, 6% white, 26% Hispanic and 66% African-American. Smoking crack cocaine was the most common non-injecting drug practice. Trend tests were used to examine HIV prevalence, demographics, drug use, sexual behavior and use of antiretroviral treatment (ART) by calendar year. Chi square and multivariable logistic regression were used to compare 2005 – 2010 versus 2011 – 2014. HIV prevalence declined approximately 1% per year (p < 0.001), with a decline from 16% in 2005 – 2010 to 8% in 2011– 2014 (p < 0.001). The percentages of participants smoking crack and having multiple sexual partners declined, the percentage of HIV positive people on ART increased. HIV incidence among repeat participants was 1.2 per 1000 person-years (95% CI 0.03/1000 - 7/1000). HIV prevalence has declined and a high percentage of HIV-positive non-injecting drug users (NIDUs) are receiving antiretroviral treatment, suggesting an end to the HIV epidemic among NIDUs in New York City. These results can be considered a proof of concept that it is possible to control non-injecting drug use related sexual transmission HIV epidemics.