Incidence of HIV Infection in a Cohort of IV Drug Users

描述（由申请方提供）：拟定的是一项为期20年的队列研究（ALIVE-2研究）的延续，该研究在马里兰州巴尔的摩的未感染HIV的注射吸毒者（IDUs）中进行，研究对象为注射吸毒流行病学和HIV风险。ALIVE队列的独特之处在于，它包括一个以社区为基础的注射吸毒者群体，其中包括基本上没有接受药物治疗的男女，非洲裔美国人和获得适当医疗服务机会有限的人占很大比例;这些人群在关于艾滋病毒感染风险人群的研究中所占比例不足。ALIVE-2为感染和风险行为的动态提供了重要见解，同时作为HIV阳性IDUs平行队列的比较组（ALIVE-1，DA 04334）。ALIVE队列的继续将使我们能够描述我们独特的老龄注射吸毒者队列中血源性感染发病率的当前趋势以及发病率和死亡率变化模式。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）检查艾滋病毒和其他血液传播感染风险的时间趋势（例如，2）根据血液传播感染的负担和药物使用的范围，评估注射吸毒者的死亡率和发病率指数; 3）描述宏观层面决定因素（例如，4）继续作为一个平台，独立供资开展艾滋病毒和吸毒问题的合作调查，包括采取干预措施，预防与吸毒、艾滋病毒和丙型肝炎病毒感染有关的发病率和死亡率。为达致这些目的，我们会继续跟进一组艾滋病病毒测试呈阴性的注射吸毒者（积极跟进1 000人），每半年进行一次探访，包括会面和收集生物样本作艾滋病病毒抗体测试和储存。我们将实施慢性病发病率的标准化评估，包括每年检测疾病的早期生物标志物以及详细的病历摘要。此外，我们将补充丰富的历史，个人层面的风险数据与外部数据的变化，在巴尔的摩的人口，经济状况，健康和药物治疗政策，使我们能够表征宏观层面的过程对风险行为的影响和途径，通过映射个人到他们的居住区。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，我们继续对HIV感染的注射吸毒者（ALIVE-1）进行平行研究，以便于区分HIV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龄注射吸毒者未来的保健需求。 公共卫生相关性：注射吸毒者感染艾滋病毒和肝炎以及这些感染的长期并发症和吸毒本身的风险很高。这项研究的结果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医疗保健需求。

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.