Risk Factors for AIDS Among Intravenous Drug Users

描述：风险因素项目研究了从1978年（使用储存血清）到现在纽约市注射吸毒者（IDUs）中非常大的艾滋病毒流行。1981年发现艾滋病时，HIV在纽约市的ldu中迅速传播，达到50%的患病率，导致纽约市ldu中有超过5万例艾滋病病例，几乎占美国所有艾滋病病例的10%。在20世纪90年代初，针对注射吸毒者的艾滋病毒预防项目得到了极大的扩展，纽约市已成为预防注射吸毒者艾滋病毒最重要的成功案例之一。自20世纪90年代初以来，ldu中的艾滋病毒发病率已从5/100人年（py）下降到1-2/ 100人年（py），患病率已从50%下降到15%以下（自1978-79年以来从未见过的水平）。在目前的预防成功案例中，仍有一些非常重要的问题需要回答：(1)在形成稳定的地方病形势之前，流行率和发病率将持续下降到何种程度？(2)目前，不同种族/族裔群体的患病率存在显著差异——黑人为25%，白人为5%，西班牙裔为8%。预防对所有种族/民族群体都是成功的吗？还是目前的差异会无限期地持续下去？(3)既然与注射有关的艾滋病毒传播已经大大减少，那么性传播在多大程度上推动了艾滋病毒的持续感染？(4)在纽约市的ldu中，减少HIV的成功是否也会导致减少丙型肝炎的成功？我们将通过以下方式解决这些问题：(a)继续对风险行为、社会网络因素、预防服务的利用、艾滋病毒流行率和艾滋病毒发病率（STAHRS检测）进行大样本横断面调查；(b) ldu和nidu之间艾滋病毒和性传播感染的数学模型；(c)纽约市不同种族群体HIV毒株遗传差异的探索性检测；(d)大样本HCV患病率调查，以及(e)定量研究，将我们的数据与纽约市对注射吸毒者和非注射吸毒者进行的其他研究相结合。拟议的研究将提供具有重大科学意义和公共卫生重要性的信息，涉及控制HIV和HCV血清高流行的预防计划的能力，解释HIV感染的种族差异，并检查HIV在ldu和nidu之间的性传播。

Description: The Risk Factors project has studied the very large HIV epidemic among injecting drug users (IDUs) in New York City from 1978 (using stored sera) to the present. HIV spread rapidly among lDUs in NYC reaching 50% prevalence by the time AIDS was discovered in 1981 and leading to over 50,000 cases of AIDS among lDUs in the city, almost 10% of all AIDS cases in the US. In the early 1990s, HIV prevention programs for IDUs were greatly expanded, and NYC has become one of the most important success stories in HIV prevention for IDUs. Since the early 1990s, HIV incidence among lDUs has declined from 5/100 person-years (py) to 1-2/ 100 py, and prevalence has declined from 50% to under 15% (a level not seen since 1978-79). There are still very important questions to be answered in this current prevention success story: (1) How far will declines in prevalence and incidence continue before a stable endemic situation develops? (2) There are currently substantial differences in prevalence among racial/ethnic groups--25% among Blacks vs. 5% among Whites, and 8% among Hispanics. Will prevention be successful for all racial/ethnic groups, or will the current differences persist indefinitely? (3) Now that injection-related HlV transmission has been greatly reduced, to what extent will continuing HIV infection be driven by sexual transmission? and (4) Will the success in reducing HIV also lead to success in reducing hepatitis C among lDUs in NYC? We will address these questions through: (a) continuation of our large-sample cross-sectional survey of risk behavior, social network factors, utilization of prevention services, HIV prevalence and HIV incidence (STAHRS testing); (b) mathematical modeling of HIV and STI transmission among lDUs and NIDUs; (c) exploratory testing of genetic differences of HIV strains among different racial ethnic groups in NYC; (d) large-sample HCV prevalence surveys, and (e) quantitative research syntheses of our data with other studies conducted on IDUs and NlDUs in NYC. The proposed research will provide information of great scientific interest and public health importance regarding the ability of prevention programs to control high HIV and HCV sero-prevalence epidemics, explaining racial ethnic differences in HIV infection, and examining sexual transmission of HIV among both lDUs and NIDUs.