INCIDENCE OF HIV INFECTIONS IN A COHORT OF IV DRUG USERS

这项研究的目的是继续分析一组未受感染的注射吸毒者(IDU)中的艾滋病毒发病率，并对感染的危险因素提供时间敏感的识别。此外，我们还将研究与注射吸毒有关的发病率和死亡率，包括丙型肝炎病毒(HCV)感染的自然病史。为了实现这些目标，我们将继续每半年对1000名艾滋病毒血清阴性的注射吸毒者进行前瞻性跟踪，其中自1988年以来，我们一直保持90%/年的随访率和2%/年以上的艾滋病毒发病率。在4年的时间内，我们将使用人员时间方法确定艾滋病毒发病率、发病率和死亡率的时间趋势。我们将使用泊松回归来确定与非法药物使用和性行为相关的特定时期的艾滋病毒风险因素和归因风险。我们建议确定使用一种新的调查方法，即音频计算机辅助自访(A-CASI)，与面试者管理的问卷相比，随着时间的推移，使用音频计算机辅助自访(A-CASI)与更高的自我报告艾滋病毒危险行为的比率相关的程度，以及这些关联与艾滋病毒血清转换的程度。这一队列的继续将使我们能够评估艾滋病毒行为干预措施(例如，针头交换和药房获得无菌注射器)的有效性，使用描述性统计和泊松回归来比较这些计划的使用者和非使用者。我们将检查艾滋病毒血清阴性注射吸毒者的发病率和死亡率，以此作为量化非法药物使用对健康影响的基础(与当地人口数据相比)，作为艾滋病毒血清转换的竞争因素(在队列中)，并作为艾滋病毒血清阳性队列(DA04334)的基础，以确定在高效抗逆转录病毒治疗时代与艾滋病毒相关的非艾滋病结果。我们将描述丙型肝炎病毒感染的自然历史和发病机制，包括评估艾滋病毒感染和丙型肝炎病毒之间的相互作用。这一队列的持续性质使快速评估新出现的血液传播病原体成为可能。11项正在进行的和已经单独资助的研究严重依赖于这群人为他们的研究提供关键的人口基础。

The purpose of this study is to continue analyses of HIV incidence among a cohort of uninfected injection drug users (IDUs), and provide time-sensitive identification of risk factors for infection. In addition, we will study morbidity and mortality associated with injection drug use, including the natural history of hepatitis C virus (HCV) infection. To meet these aims, we will continue to prospectively follow 1000 HIV-seronegative IDUs on a semi-annual basis, among whom we have maintained a follow-up rate of 90 percent/yr and an HIV incidence greater than 2 percent/year since 1988. Over a 4 year period, we will identify temporal trends in HIV incidence and morbidity and mortality using person-time methods. We will determine period-specific HIV risk factors and attributable risks associated with illicit drug use and sexual behaviors using Poisson regression. We propose to determine the extent to which the use of a new survey method, audio computer-assisted self- interviewing (A-CASI) is associated with higher rates of self-reported HIV risk behaviors over time compared to interviewer-administered questionnaires, and the magnitude of these associations with respect to HIV seroconversion. Continuation of this cohort will enable us to evaluate the effectiveness of HIV behavioral interventions (e.g. needle exchange and pharmacy access to sterile syringes), using descriptive statistics and Poisson regression to compare users/non-users of these programs. We will examine morbidity and mortality in HIV seronegative IDUs as a basis for quantifying health effects of illicit drug use (compared to local population data), as a competing factor for HIV seroconversion (within the cohort), and as a basis for an HIV-seropositive cohort (DA04334) to identify HIV-related non-AIDS outcomes in the era of highly active antiretroviral therapy. We will characterize the natural history and pathogenesis of HCV infection including evaluation of interactions between HIV infection and HCV. The ongoing nature of this cohort allows for rapid assessment of emerging blood-borne pathogens. Eleven ongoing and already separately funded studies critically depend on this cohort to provide a key population base for their studies.