Incidence of HIV Infection in a Cohort of IV Drug Users

摘要 建议继续进行一项长达20年的关于注射吸毒和艾滋病毒风险的流行病学队列研究。 在马里兰州巴尔的摩的未感染艾滋病毒的注射吸毒者中，这项研究被称为Alive-2研究。活着的人 队列是独一无二的，因为它包括以社区为基础的吸毒者群体，无论男女，他们基本上都不是 毒品治疗，非洲裔美国人和那些获得药物治疗机会有限的人占很大比例 适当的医疗护理；这些人群在关于艾滋病高危人群的研究中代表性不足 艾滋病毒感染。Alive-2提供了对感染动态和危险行为的关键洞察，而 作为与艾滋病毒阳性注射人群(Alive-1，DA04334)平行队列的对照组。延续 活着的队列将使我们能够表征当前血液传播感染发病率的趋势和 在我们独特的老年注射吸毒者队列中，发病率和死亡率的模式发生变化。此外，我们会考虑 风险行为、发病率和死亡率的更广泛的背景决定因素。在20年的基础上发展壮大 在研究注射吸毒对健康影响的后续行动和经验方面，我们的具体目标是：1) 检查注射毒品中艾滋病毒和其他血液传播感染(如丙型肝炎病毒)风险的时间趋势 马里兰州巴尔的摩的使用者；2)根据注射吸毒者的负担评估注射吸毒者的死亡率和发病率指数 血液传播感染和药物使用谱；3)表征宏观决定因素的影响 (例如，城市重建和药物治疗政策)对艾滋病毒危险行为、血液传播感染发生率的影响 和发病率以及4)继续作为独立资助的合作调查的平台 艾滋病毒与药物使用，包括预防与药物使用有关的发病率和死亡率的干预措施 丙型肝炎病毒感染。为了达到这些目标，我们将继续跟进一批艾滋病毒阴性的注射吸毒者(1000人在 积极的后续行动)每半年进行一次访问，包括访谈和收集艾滋病毒的生物标本 抗体检测和储存库。实施慢性病发病率标准化评估。 这包括对疾病的早期生物标记进行年度测试，以及详细的病历摘要。 此外，我们将用有关以下方面变化的外部数据补充个人层面风险数据的丰富历史 巴尔的摩的人口、经济状况以及卫生和药物治疗政策，这样我们就可以 宏观层面的过程对风险行为的影响及其作用途径 将个人映射到他们居住的社区。包括美国人口普查在内的多个外部来源 巴尔的摩社区指标联盟将被使用。为了丰富我们的分析，我们继续 艾滋病毒感染注射吸毒者平行议定书(Alive-1)，以促进区分艾滋病毒和药物使用对 我们感兴趣的结果。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 帮助预测发病率不断变化的老年注射吸毒者未来的卫生保健需求。相关性 注射吸毒者(注射吸毒者)感染艾滋病毒和肝炎的风险很高，长期并发症 这些感染以及药物使用本身也是如此。这项研究的发现将为艾滋病毒的预防和 结构性干预措施，并将有助于预测老年注射吸毒者未来的卫生保健需求 发病率的谱系。

Abstract 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. 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.