Incidence of HIV Infection in a Cohort of IV Drug Users

描述（由申请人提供）：拟继续在马里兰州巴尔的摩进行的一项为期20年的注射吸毒流行病学和未感染HIV的注射吸毒者（IDUs）的HIV风险队列研究，称为ALIVE-2研究。ALIVE队列的独特之处在于，它包括以社区为基础的IDU人口，男女都有，他们大部分没有接受药物治疗，其中非洲裔美国人和获得适当医疗保健的机会有限的人占很大比例；在关于艾滋病毒感染风险人群的研究中，这些人群的代表性不足。ALIVE-2提供了对感染动态和风险行为的重要见解，同时作为HIV阳性IDUs平行队列的对照组（ALIVE-1, DA04334）。ALIVE队列的继续将使我们能够描述我们独特的老年注射吸毒者队列中血源性感染发生率的当前趋势以及发病率和死亡率的变化模式。此外，我们将考虑风险行为、疾病发病率和死亡率的更广泛的背景决定因素。基于20年的随访和研究注射吸毒对健康影响的经验，我们的具体目标是：1)检查马里兰州巴尔的摩注射吸毒者中艾滋病毒和其他血源性感染（如丙型肝炎病毒）风险的时间趋势；2)根据血源性感染负担和用药谱评估注射吸毒者的死亡率和发病率指标；3)表征宏观层面决定因素（如城市再开发和药物治疗政策）对艾滋病毒风险行为、血液传播感染发病率和发病率的影响；4)继续作为独立资助的艾滋病毒和吸毒合作调查的平台，包括预防与吸毒、艾滋病毒和HCV感染相关的发病率和死亡率的干预措施。为了实现这些目标，我们将继续对艾滋病毒阴性注射吸毒者进行随访（积极随访1000人），每半年进行一次随访，包括面谈和收集用于艾滋病毒抗体检测和储存的生物标本。实施慢性病发病率标准化评估，包括年度疾病早期生物标志物检测和详细病历提取。此外，我们将用巴尔的摩人口、经济状况、健康和药物治疗政策变化的外部数据来补充个人层面风险数据的丰富历史，这样我们就可以通过将个人映射到他们居住的社区，来描述宏观层面过程对风险行为的影响，以及它们运作的途径。将使用多个外部来源，包括美国人口普查和巴尔的摩邻里指标联盟。为了丰富我们的分析，我们继续进行艾滋病毒感染注射吸毒者的平行方案（ALIVE-1），以促进区分艾滋病毒和药物使用对我们感兴趣的结果的影响。拟议的目标将为艾滋病毒预防和结构性干预提供信息，并将有助于预测发病率不断变化的老年注射吸毒者未来的保健需求。

DESCRIPTION (provided by applicant): Proposed is a continuation of a 20 year cohort study of the epidemiology of injection drug use and HIV risk among HIV-uninfected injection drug users (IDUs) in Baltimore, MD known as the ALIVE-2 study. The ALIVE cohort is unique in that it comprises a community-based IDU population of both genders who are largely out of drug treatment, with significant representation of African-Americans and those with limited access to appropriate medical care; these populations have been underrepresented in research on persons at risk for HIV infection. ALIVE-2 has provided critical insight into the dynamics of infection and risk behavior while serving as a comparison group to a parallel cohort of HIV positive IDUs (ALIVE-1, DA04334). Continuation of the ALIVE cohort will allow us to characterize current trends in the incidence of blood-borne infections and changing patterns of morbidity and mortality among our unique cohort of aging IDUs. Further, we will consider the broader contextual determinants of risk behavior, disease incidence and mortality. Building upon 20 years of follow-up and experience in studying the health effects of injection drug use, our specific aims are to: 1) Examine temporal trends in risk of HIV and other blood-borne infections (e.g., HCV) among injection drug users in Baltimore, MD; 2) Assess mortality and morbidity indices among IDUs according to the burden of blood-borne infections and the spectrum of drug use; 3) Characterize the effects of macro-level determinants (e.g., urban redevelopment and drug treatment policy) on HIV risk behaviors, blood-borne infection incidence and morbidity and 4) Continue to serve as a platform for independently funded collaborative investigations of HIV and drug use, including interventions to prevent morbidity and mortality associated with drug use, HIV and HCV infection. To achieve these aims, we will continue follow-up of a cohort of HIV negative IDUs (1000 in active follow-up) with semiannual visits involving interviews and collection of biological specimens for HIV antibody testing and repository. We will implement standardized assessments of chronic disease morbidity that include annual testing of early biological markers of disease as well as detailed medical record abstraction. Further, we will supplement the rich history of individual-level risk data with external data on changes in Baltimore's population, economic situation, and health and drug treatment policies so that we can characterize the effects of macro-level processes on risk behavior and the pathways through which they operate by mapping individuals to their neighborhoods of residence. Multiple external sources including the US Census and the Baltimore Neighborhood Indicators Alliance will be used. To enrich our analyses, we continue a parallel protocol of HIV-infected IDUs (ALIVE-1) to facilitate distinction of the effects of HIV and drug use on our outcomes of interest. The proposed aims will inform HIV prevention and structural interventions and will help to project future health care needs for aging IDUs with a changing spectrum of morbidity. PUBLIC HEALTH RELEVANCE: Injection drug users (IDUs) are at high risk for HIV and hepatitis infections and the long-term complications of these infections as well as drug use itself. The findings from this study will inform HIV prevention and structural interventions and will help to project the future health care needs for aging IDUs with a changing spectrum of morbidity.