Intensive injection cocaine use as the primary risk factor in the Vancouver HIV-1 epidemic
Intensive injection cocaine use as the primary risk factor in the Vancouver HIV-1 epidemic
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DOI：
10.1097/00002030-200304110-00014
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发表时间：
2003-04-11
期刊：
影响因子：
3.8
通讯作者：
Schechter, MT
中科院分区：
文献类型：
--
作者：
Tyndall, MW;Currie, S;Schechter, MT
目标：温哥华与注射吸毒相关的 HIV-1 疫情持续爆发并持续受到国际关注。本研究旨在确定可卡因使用模式如何影响 HIV 感染风险。 方法：温哥华注射吸毒者研究是一项针对注射吸毒者的开放前瞻性队列，于 1996 年 5 月开始。在入组和半年随访时，访谈员会进行详细的半结构化调查问卷。 Cox 比例风险模型用于确定 HIV 血清转化前 6 个月报告的行为和药物使用模式。结果：在平均 31 个月的随访期间，从 940 名 HIV 血清阴性参与者中观察到 109 起 HIV 感染事件。在血清转化前的 6 个月内，HIV 感染的预测因素包括注射可卡因 [调整后风险比 (AHR, 3.72)]、监禁 (AHR, 2.74)、住房不稳定 (AHR, 2.36)、美沙酮维持治疗 (AHR, 1.98) 和原住民种族 (AHR, 1.78)。注射可卡因可以剂量依赖性方式预测艾滋病毒感染。与不经常吸食可卡因的人相比，平均每天注射超过 3 次的参与者感染艾滋病毒的可能性高出七倍。此外，定期注射可卡因的人感染艾滋病毒的时间会缩短，而与同时使用海洛因无关。结论：在这种多重吸毒人群中，注射可卡因是艾滋病毒血清转化的一个强有力的、剂量依赖性的预测因素。注射可卡因使用者仍然特别容易感染艾滋病毒，而可卡因依赖的治疗选择仍然严重不足。 (C) 2003 年利平科特·威廉姆斯·威尔金斯。
Objectives: The explosive and ongoing injecting drug use-related HIV-1 epidemic in Vancouver continues to receive international attention. This study was conducted to determine how patterns of cocaine use influence the risk of HIV infection.Methods: The Vancouver Injection Drug Users Study is an open prospective cohort of injecting drug users that began in May 1996. At enrollment and at semi-annual follow-up visits an interviewer administers a detailed semi-structured questionnaire. Cox proportional hazards models were used to determine behavioral and drug use patterns reported in the 6 months prior to HIV seroconversion.Results: One-hundred and nine incident HIV infections have been observed during a mean follow-up of 31 months, from 940 HIV-seronegative participants. During the 6 months prior to seroconversion, predictors of HIV infection were injecting cocaine use [adjusted hazards ratio (AHR), 3.72], incarceration (AHR, 2.74), unstable housing (AHR, 2.36), methadone maintenance treatment (AHR, 1.98), and Aboriginal ethnicity (AHR, 1.78). Injecting cocaine use was predictive of HIV infection in a dose-dependent fashion. Compared with infrequent cocaine users, participants who averaged more than three injections per day were seven times more likely to contract HIV. In addition, the time to HIV infection was accelerated among regular cocaine injectors independent of concurrent heroin use.Conclusions: Injecting cocaine use was a strong, dose-dependent predictor of HIV seroconversion in this poly-drug using population. Injection cocaine users remain particularly vulnerable to HIV infection and treatment options for cocaine dependency remain woefully inadequate. (C) 2003 Lippincott Williams Wilkins.