RISK-FACTORS FOR HUMAN-IMMUNODEFICIENCY-VIRUS SEROCONVERSION AMONG OUT-OF-TREATMENT DRUG INJECTORS IN HIGH AND LOW SEROPREVALENCE CITIES
RISK-FACTORS FOR HUMAN-IMMUNODEFICIENCY-VIRUS SEROCONVERSION AMONG OUT-OF-TREATMENT DRUG INJECTORS IN HIGH AND LOW SEROPREVALENCE CITIES
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DOI：
10.1093/oxfordjournals.aje.a117726
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发表时间：
1995-10-15
影响因子：
5
通讯作者：
NEAIGUS, A
中科院分区：
文献类型：
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作者：
FRIEDMAN, SR;JOSE, B;NEAIGUS, A
从1988年到1991年，对美国15个城市的6882名吸毒者进行了采访，并采集了血清样本。对访谈和样本进行分析，以确定10个低血清阳性城市和5个高血清阳性城市人类免疫缺陷病毒(HIV)血清转换的显著预测因素。分析单位为连续配对访谈/血样之间的观察期。在COX比例风险回归分析中，低血清阳性率城市血清转换的显著预测因素是：未接受药物治疗、在户外场所或废弃建筑物注射、每周或更频繁地吸食强效可卡因、从事妇女与女性之间的性行为、非拉丁裔种族/民族和城市血清阳性率。高血清阳性率城市的预测因素是：注射可能受感染的注射器，没有接受药物治疗，以及有注射毒品的性伴侣。这些发现表明，艾滋病毒可能集中在低血清阳性率城市的社会行为感染区域。为了减少艾滋病毒的传播，这些结果建议：1)在血清阳性率低的城市，进行本地化监测，以发现特定的新出现的社会行为感染，并在必要时迅速实施适当的有针对性的干预措施；2)在血清阳性率高的城市，相对更多地强调全区推广和注射器交换项目，以减少危险行为；以及3)在这两类城市，相当大程度上扩大药物治疗计划。
From 1988 to 1991, 6,882 drug injectors in 15 US cities were interviewed and had serum samples collected. The interviews and samples were analyzed for determination of significant predictors of human immunodeficiency virus (HIV) seroconversion in the 10 low seroprevalence cities and the five high seroprevalence cities. The unit of analysis was the period of observation between consecutive paired interviews/blood samples. In Cox proportional hazards regression, significant predictors of seroconversion in the low seroprevalence cities were: not being in drug treatment, injecting in outdoor settings or abandoned buildings, using crack cocaine weekly or more frequently, engaging in woman-to-woman sex, being of non-Latino race/ethnicity, and city seroprevalence. Predictors in high seroprevalence cities were: injecting with potentially infected syringes, not being in drug treatment, and having a sex partner who injected drugs. These findings suggest that HIV may be concentrated in sociobehavioral pockets of infection in low seroprevalence cities. For reducing HIV transmission, these results suggest: 1) in low seroprevalence cities, localized monitoring to detect specific emerging sociobehavioral pockets of infection, and quick implementation of appropriate targeted interventions if necessary; 2) in high seroprevalence cities, relatively mor emphasis on locality-wide outreach and syringe-exchange projects to reduce risky behavior; and 3) in both types of cities, considerable expansion of drug treatment programs.