Risk Factors for AIDS among Drug Users: Getting Close to Zero

描述(由申请者提供)：联合国艾滋病规划署宣布了一个目标：“实现零新的艾滋病毒感染”，国务卿克林顿宣布了一个目标，即“一个没有艾滋病的一代”。在任何大量艾滋病毒高危人群中，彻底消除新的艾滋病毒感染可能是不可能的，但我们现在有可能拥有科学和公共卫生工具，使新的艾滋病毒感染“接近于零”。“接近于零”(CTZ)新的艾滋病毒感染可在操作上被定义为达到以下流行状况：艾滋病毒感染率非常低和稳定，绝大多数(80+%)艾滋病毒感染者正在接受抗逆转录病毒治疗，R0(基本生育率)和1.0，艾滋病毒发病率稳定，以及艾滋病毒/100人年中的0.1；以及艾滋病毒中的性别和种族/族裔差异已最小化。针对注射吸毒者的“综合艾滋病毒预防”(PWID)在许多高收入环境中相当成功，有可能在PWID中实现“接近于零”的新感染。需要在两个相关和非常重要的公共卫生问题的背景下研究接近零的PWID新的艾滋病毒感染：非注射吸毒者中与毒品有关的艾滋病毒性传播(NIDU)和PWID中的丙型肝炎病毒(丙型肝炎病毒)传播。纽约市经历了世界上最大的艾滋病和丙型肝炎病毒在PWID中的流行，可能是世界上最大的艾滋病在死亡者中的流行，并对PWID和死亡者实施了联合预防。这项拟议的研究有四个具体目标：1.确定纽约市“联合预防”在多大程度上接近于零注射相关传播。采用“社区危险行为/艾滋病毒病毒血症”和“社区危险行为/混合感染”的措施来描述和衡量这种CTZ情况。评估目前注射吸毒者传播艾滋病毒的性别和种族/族裔差异是否持续存在于禁毒区的情况。2.确定纽约市非注射吸毒者(NIDU)中与毒品相关的性传播(DRS)的“综合预防”接近零的程度。应用“社区危险行为/HIV病毒血症”和“社区危险行为/混合感染”来描述和衡量CTZ-DRS传播流行情况。评估目前艾滋病毒在DRS传播方面的性别和种族/族裔差异是否持续存在于禁毒区的情况。3.监测丙型肝炎病毒流行的趋势，并对美沙酮患者中丙型肝炎病毒的发病率进行队列研究，以评估纽约市PWID中丙型肝炎病毒流行下降的可能性。4.利用地理空间分析，确定纽约市吸毒者中艾滋病毒、单纯疱疹病毒2型和丙型肝炎病毒持续传播的“热点”。这些目标将通过继续我们对在纽约接受药物使用治疗的人中的危险行为、艾滋病毒、丙型肝炎病毒和单纯疱疹病毒2型的长期研究(每年600名新受试者)、使用我们药物治疗计划的电子健康记录(每年6000名患者记录)以及与市卫生局的积极合作来实现。

DESCRIPTION (provided by applicant): UNAIDS has announced a goal of "Getting to Zero New HIV infections" and Secretary Clinton has announced a goal of "an AIDS free generation." Completely eliminating new HIV infections may not be possible in any large population of persons at high risk for HIV, but it is possible that we now have the scientific and public health tools to get very "close to zero" new HIV infections. Getting "close to zero" (CTZ) new HIV infections may be operationally defined as reaching an endemic situation where: HIV prevalence is very low and stable, the great majority (80+%) of HIV+ persons are receiving ART, R0 (the basic reproductive rate) < 1.0, HIV incidence is stable and < 0.1/100 person-years, and gender and racial/ethnic disparities in HIV have been minimized. "Combined HIV prevention" for persons who inject drugs (PWID), has been quite successful in many high-income settings, and it may be possible to achieve "close to zero" new infections among PWID. Getting close to zero new HIV infections for PWID needs to be studied in the context of two related and very substantial public health problems: drug related sexual transmission of HIV among non-injecting drug users (NIDUs) and hepatitis C virus (HCV) transmission among PWID. New York City has experienced the world's largest HIV and HCV epidemics among PWID, probably the world's largest HIV epidemic among NIDUs, and has implemented combined prevention for PWID and NIDUs. There are four Specific Aims for the proposed research: 1. Determine the extent to which "combined prevention" is getting close to zero injecting related transmission in NYC. Apply measures of "community risk behavior/HIV viremia" and "community risk behavior/co-infection" for describing and measuring such a CTZ situation. Assess whether the current gender and racial/ethnic disparities for IDU transmission of HIV persist in a CTZ situation. 2. Determine the extent to which "combined prevention" is getting close to zero for drug related sexual (DRS) transmission among non-injecting drug users (NIDUs) in NYC. Apply measures of "community risk behavior/HIV viremia" and "community risk behavior/co-infection" for describing and measuring a CTZ DRS transmission endemic situation. Assess whether the current gender and racial/ethnic disparities for DRS transmission of HIV persist in a CTZ situation. 3. Monitor trends in HCV prevalence and conduct a cohort study of HCV incidence among methadone patients to assess the potential for a declining epidemic of HCV among PWID in NYC. 4. Utilize geospatial analysis to characterize "hotspots" for continuing transmission of HIV, HSV-2, and HCV among drug users in NYC. These will be achieved through continuation of our long-standing research on risk behavior, HIV, HCV and HSV-2 among persons entering drug use treatment in New York (600 new subjects per year), use of electronic health records from our drug treatment programs (6000 patient records per year), and an active collaboration with the city Department of Health.