Continuity and change within an HIV epidemic. Injecting drug users in New York City, 1984 through 1992.
Continuity and change within an HIV epidemic. Injecting drug users in New York City, 1984 through 1992.
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DOI：
10.1001/jama.1994.03510260053028
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发表时间：
1994-01
期刊：
影响因子：
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通讯作者：
D. C. Jarlais;S. R. Friedman;J. L. Sotheran;J. Wenston;M. Marmor;S. Yancovitz;B. Frank;S. Beatrice;D. Mildvan
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文献类型：
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作者：
D. C. Jarlais;S. R. Friedman;J. L. Sotheran;J. Wenston;M. Marmor;S. Yancovitz;B. Frank;S. Beatrice;D. Mildvan
目的研究1984年至1992年纽约市注射吸毒者（IDUs）中获得性免疫缺陷综合征（AIDS）危险行为和人类免疫缺陷病毒（HIV）血清阳性率的趋势。设计和设置比较两次调查的注射吸毒者在同一医院为基础的纽约市药物滥用戒毒计划：141注射吸毒者在1984年和974注射吸毒者在1990年至1992年。还使用了国家死亡登记处、纽约市卫生局和药物治疗项目记录。参与者参加戒毒计划的人随机选择参加。合格性基于前2个月内注射;获得99%的接受率。1984年和1990年至1992年调查的参与者分别为66%和79%的男性、21%和19%的白色、33%和34%的非裔美国人以及45%和46%的拉丁美洲人。以社区为基础的艾滋病预防计划，包括地下注射器交换。主要观察指标：获得性免疫缺陷综合征危险行为; HIV血清状态; CD 4+细胞计数; 1984例受试者的死亡率;注射和鼻内给药途径。结果HIV感染率稳定在50%以上。平均CD 4+细胞计数从0.716 x 10（9）/L（716/微升）下降至0.575 x 10（9）/L（P < .009）。1984名受试者的年死亡率为3%，HIV血清阳性受试者的死亡率显著更高（相对危险度为2.57; 95%精确二项置信区间为1.12至6.61）。在艾滋病危险行为中观察到大规模的下降，例如，使用潜在污染的注射器从注射的51%下降到7%（P <0.001）。最近的额外风险降低与使用地下注射器交换有关。鼻内海洛因使用是纽约市药物治疗项目中46%的海洛因入院者的主要给药途径。结论近10年来，纽约市静脉吸毒人群中HIV血清阳性率保持稳定。继续目前的趋势应导致艾滋病毒传播的进一步减少，虽然逆转鼻内使用的趋势可能导致传播的大幅增加。
OBJECTIVES To examine trends in acquired immunodeficiency syndrome (AIDS) risk behavior and human immunodeficiency virus (HIV) seroprevalence among injecting drug users (IDUs) in New York City from 1984 through 1992. DESIGN AND SETTING Comparisons were made between two surveys of IDUs at the same hospital-based New York City drug abuse detoxification program: 141 IDUs in 1984 and 974 IDUs in 1990 through 1992. National Death Registry, New York City Health Department, and drug treatment program records were also used. PARTICIPANTS Persons attending detoxification program randomly selected for participation. Eligibility was based on injection within previous 2 months; 99% acceptance rates were obtained. Participants in the 1984 and 1990 through 1992 surveys were 66% and 79% men, 21% and 19% white, 33% and 34% African American, and 45% and 46% Latin American, respectively. INTERVENTIONS Community-based AIDS prevention programs, including underground syringe exchanges. MAIN OUTCOME MEASURES Acquired immunodeficiency syndrome risk behaviors; HIV serostatus; CD4+ cell counts; death rates among 1984 subjects; and injection and intranasal routes of drug administration. RESULTS The HIV seroprevalence remained stable at slightly more than 50%. Mean CD4+ cell counts declined from 0.716 x 10(9)/L (716/microL) to 0.575 x 10(9)/L (P < .009). Annual death rate among 1984 subjects was 3%, with a significantly higher rate among HIV-seropositive subjects (relative risk, 2.57; 95% exact binomial confidence interval, 1.12 to 6.61). Large-scale declines were observed in AIDS risk behaviors, eg, use of potentially contaminated syringes declined from 51% to 7% of injections (P < .001). Recent additional risk reduction was associated with use of the underground syringe exchanges. Intranasal heroin use was the primary route of drug administration for 46% of heroin admissions to New York City drug treatment programs. CONCLUSIONS The HIV seroprevalence has remained stable among this population of New York City IDUs for almost a decade. Continuation of current trends should lead to further reduction in HIV transmission, although reversal of the trend to intranasal use could lead to substantially increased transmission.