INCIDENCE OF HIV INFECTION IN A COHORT OF IV DRUG USERS

说明（由申请人提供）：本提案是对一个自1988年以来一直存在的项目的竞争性延续，该项目记录了注射吸毒者的自然史和治疗史以及他们所患的主要与艾滋病毒有关的感染和疾病。 目前的更新提出了四个主要目标：（1）评价艾滋病毒发病率的时间趋势，并确定特定时期的风险因素和归因风险与非法药物使用和性行为的男性和女性艾滋病毒血清阴性注射吸毒者队列。 使用层次模型，他们将确定与宏观风险因素相关的相对风险和可归因风险（如邻里社会劣势和海洛因纯度）与个人水平的艾滋病毒风险相比;（2）描述非法注射药物使用的自然史，包括与开始、复吸和停止相关的行为和社会人口因素，使用考克斯和泊松回归考虑整个寿命期内的队列和阶段效应;（3）确定与非法药物使用和合并症有关的艾滋病毒血清反应阴性的注射吸毒者与感染艾滋病毒的注射吸毒者的平行队列相比的发病率和发病率及死亡率的时间趋势，（4）确定HCV感染的注射吸毒者中HCV治疗的资格，并使用病例交叉设计确定与治疗资格的注射吸毒者中获得和利用治疗相关的个人和环境障碍。

DESCRIPTION (provided by the applicant): This proposal is a competing renewal for a project, extant since 1988, that has chartered the natural and treated history of injecting drug users and the infections and illnesses, primarily HIV-related, to which they are subject. The current renewal proposes four major aims: (1) To evaluate temporal trends in HIV incidence, and determine period-specific risk factors and attributable risks associated with illicit drug use and sexual behaviors in a cohort of male and female HIV seronegative IDUs. Using hierarchical modeling, they will identify relative and attributable risks associated with macro-level risk factors (such as neighborhood social disadvantage and heroin purity) compared to individual-level HIV risks; (2) To characterize the natural history of illicit injection drug use, including behavioral and sociodemographic factors associated with initiation, relapse, and cessation, taking into account cohort and period effects across the lifespan using Cox and Poisson regression; (3) To determine incidence and temporal trends in morbidity and mortality among HIV seronegative IDUs associated with illicit drug use and co-morbid conditions compared to a parallel cohort of HIV-infect IDUs, to differentiate between morbidity related to HIV and HAART compared to drug use itself; (4) To determine HCV treatment eligibility among HCV-infected IDUs and identify individual and environmental barriers associated with access and utilization of treatment among treatment-eligible IDUs using a case-crossover design.