Vulnerable infected populations and street markets for ARVs: Potential implications for PrEP rollout in the USA.
Vulnerable infected populations and street markets for ARVs: Potential implications for PrEP rollout in the USA.
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ARV的脆弱感染人群和街头市场：对美国的预付款的潜在影响。
DOI：
10.1080/09540121.2013.837139
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发表时间：
2014-04
期刊：
影响因子：
1.7
通讯作者：
Surratt HL
中科院分区：
文献类型：
--
作者：
Kurtz SP;Buttram ME;Surratt HL
抗逆转录病毒（ARV）药物在南佛罗里达州贫困患者中被广泛转用于非法市场的情况近期已有记录。近期抗逆转录病毒药物被批准用于暴露前预防（PrEP），这有可能扩大这些非法市场，因为高危个体在无处方或无医疗监督的情况下寻求抗逆转录病毒药物。药物转用者的不依从以及在无监督情况下将抗逆转录病毒药物用于治疗或PrEP会增加治疗失败、耐药和疾病传播的风险。我们报告了南佛罗里达州男男性行为吸毒者中抗逆转录病毒药物转用的范围。结构化访谈（N = 515）询问了人口统计学信息、艾滋病病毒感染状况、精神痛苦、药物依赖和性风险。艾滋病病毒阳性参与者回答了有关医疗护理、治疗以及抗逆转录病毒药物依从性和转用的问题。中位年龄为39岁。在艾滋病病毒阳性率为46.4%的人群中，79.1%的人被开具了抗逆转录病毒药物。其中，27%的人报告出售/交易抗逆转录病毒药物。转用的原因包括与朋友分享/交易、为钱/毒品出售/交易以及出售/交易未使用的药物。与非转用者相比，抗逆转录病毒药物转用者更有可能药物依赖（74.5%对58.7%，p = 0.046），并且更有可能为钱/毒品进行性交易（60.8%对32.6%，p < 0.001）；且不太可能依从抗逆转录病毒药物治疗（54.9%对73.9%，p = 0.012）。在高危男男性行为者群体中，抗逆转录病毒药物转用应受到特别关注，因为此类群体中的未感染男性可能从PrEP中获益最大，但不太可能通过医疗保健系统获得PrEP和必要的辅助服务。在制定政策和行为支持以扩大治疗即预防以及PrEP时，应仔细考虑转用对治疗失败、疾病传播和PrEP失败风险增加的影响。
Widespread diversion of antiretroviral (ARV) medications to illicit markets has recently been documented among indigent patients in South Florida. The recent approval of ARVs for pre-exposure prophylaxis (PrEP) has the potential to broaden these illicit markets, as high risk individuals seek ARVs without a prescription or medical supervision. Non-adherence among diverters and unsupervised use of ARVs for treatment or PrEP increase risks of treatment failure, drug resistance, and disease transmission. We report the scope of ARV diversion among substance using men who have sex with men in South Florida. Structured interviews (N=515) queried demographics, HIV status, mental distress, substance dependence, and sexual risks. HIV-positive participants answered questions about medical care, treatment, and ARV adherence and diversion. Median age was 39. Of 46.4% who were HIV-positive, 79.1% were prescribed ARVs. Of these, 27% reported selling/trading ARVs. Reasons for diversion were sharing/trading with friends, sale/trade for money/drugs, and sale/trade of unused medications. ARV diverters, compared to non-diverters, were more likely to be substance dependent (74.5% vs. 58.7%, p=.046) and have traded sex for money/drugs (60.8% vs. 32.6%, p<.001); and less likely to be adherent to ARVs (54.9% vs. 73.9%, p=.012). ARV diversion should be a particular concern in communities of high risk MSM, as uninfected men in such communities are likely to benefit most from PrEP but unlikely to have access to PrEP and necessary ancillary services through the health care system. The implications of diversion for increased risks of treatment failure, disease transmission, and PrEP failure should be carefully considered in developing policy and behavioral supports to scaling up treatment as prevention and PrEP.
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影响因子：
11.8
作者：
Hurt, Christopher B.;Eron, Joseph J., Jr.;Cohen, Myron S.
通讯作者：
Cohen, Myron S.
影响因子：
3.8
作者：
Bangsberg, DR;Perry, S;Moss, A
通讯作者：
Moss, A
影响因子：
3.1
作者：
Inciardi, James A.;Surratt, Hilary L.;Cicero, Theodore J.
通讯作者：
Cicero, Theodore J.
DOI：
10.1097/qai.0b013e31818d5a27
发表时间：
2009-01-01
期刊：
Journal of acquired immune deficiency syndromes (1999)
影响因子：
--
作者：
Mimiaga MJ;Case P;Johnson CV;Safren SA;Mayer KH
通讯作者：
Mayer KH
影响因子：
3.7
作者：
Krakower DS;Mimiaga MJ;Rosenberger JG;Novak DS;Mitty JA;White JM;Mayer KH
通讯作者：
Mayer KH