INCIDENCE OF HIV INFECTION IN A COHORT OF IV DRUG USERS

描述（由申请人提供）：本提案是一个自1988年以来一直存在的项目的竞争性更新，该项目记录了注射吸毒者的自然和治疗史，以及他们所遭受的感染和疾病，主要与艾滋病毒有关。本次更新提出了四个主要目标：(1)评估HIV发病率的时间趋势，确定与男性和女性HIV血清阴性IDUs队列中非法药物使用和性行为相关的特定时期风险因素和归因风险。使用分层模型，他们将识别与宏观层面风险因素（如社区社会劣势和海洛因纯度）相关的相对风险和归因风险，并与个人层面的艾滋病毒风险进行比较；(2)利用Cox和Poisson回归分析非法注射药物使用的自然历史特征，包括与开始、复发和停止相关的行为和社会人口因素，并考虑整个生命周期的队列和时期效应；(3)确定与艾滋病毒感染注射吸毒者平行队列相比，与非法药物使用相关的艾滋病毒血清阴性注射吸毒者发病率和死亡率的发病率和时间趋势，以及与吸毒本身相比，与艾滋病毒和HAART相关的发病率和死亡率；(4)采用病例交叉设计确定丙型肝炎病毒感染注射吸毒者的治疗资格，并确定与治疗资格的注射吸毒者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.