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

描述（由申请人提供）：联合国艾滋病规划署宣布了“实现零新增艾滋病感染”的目标，国务卿克林顿宣布了“无艾滋病一代”的目标。在任何艾滋病毒高风险人群中，完全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非常“接近于零”。“接近零”（CTZ）新发艾滋病毒感染在操作上可以定义为达到一种流行情况：艾滋病毒流行率非常低且稳定，绝大多数（80%以上）艾滋病毒阳性患者正在接受抗逆转录病毒治疗，R0（基本生殖率）< 1.0，艾滋病毒发病率稳定且< 0.1/100人年，艾滋病毒的性别和种族/民族差异已被最小化。针对注射毒品者的“艾滋病毒综合预防”在许多高收入环境中取得了相当成功，并且有可能在注射毒品者中实现“接近零”新感染。需要在两个相关且非常重大的公共卫生问题的背景下研究艾滋病毒新感染接近零的问题：艾滋病毒在非注射吸毒者（NIDUs）中的药物相关性传播和艾滋病毒在PWID中的丙型肝炎病毒（HCV）传播。纽约市在艾滋病毒感染者中经历了世界上最大的艾滋病毒和丙型肝炎病毒流行，可能是世界上最大的艾滋病病毒流行在NIDUs中，并实施了对PWID和NIDUs的联合预防。提出的研究有四个具体目的：1。确定纽约市“联合预防”在多大程度上接近于与注射相关的零传播。使用“社区风险行为/HIV病毒血症”和“社区风险行为/合并感染”的度量来描述和测量这种CTZ情况。评估目前的性别和种族/民族差异在注射吸毒者传播艾滋病毒的情况下是否持续存在。2. 确定纽约市非注射吸毒者（NIDUs）中与毒品有关的性传播（DRS）的“联合预防”接近于零的程度。应用“社区风险行为/HIV病毒血症”和“社区风险行为/合并感染”的措施来描述和测量CTZ - DRS传播的流行情况。评估目前DRS传播艾滋病毒的性别和种族/民族差异是否在CTZ情况下持续存在。3. 监测HCV流行趋势，并对美沙酮患者中HCV发病率进行队列研究，以评估纽约市PWID中HCV流行下降的可能性。4. 利用地理空间分析来描述纽约市吸毒者中HIV、HSV-2和HCV持续传播的“热点”。这些目标将通过我们长期以来对纽约接受药物治疗的人的风险行为、HIV、HCV和HSV-2的研究（每年600名新受试者）、使用我们药物治疗项目的电子健康记录（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.