Sexual Risk Behavior Among Injection Drug Users Before Widespread Availability of Highly Active Antiretroviral Therapy

HIV testing and counseling has been associated with reductions in risk behaviors in some populations. This study examined whether involvement in a long-term study, including exposure to repeated HIV testing and counseling, was associated with increased condom use among injection drug users (IDUs) through a retrospective analysis of an IDU cohort from Baltimore, MD, during 1994–1998. Eligibility included being aged 18 years or older, injecting within 10 years and not having initiated antiretroviral therapy. A logistic model of high versus low risk, based on condom use, was used. Of 322 eligible IDUs, most were male (66%) and African-American (94%). No significant change in the odds of inconsistent condom use was observed with continued study exposure. Condom use remained low, indicating a need for interventions to reduce sexual risks and HIV transmission in this population.     

Time on antiretroviral therapy is a protective factor for liver fibrosis in HIV and hepatitis C virus (HCV) co-infected patients

summary. To assess the factors associated with liver fibrosis in human immunodeficiency virus and hepatitis C virus (HIV/HCV) co-infected patients eligible for anti-HCV therapy, we performed an observational, single-centred, cross-sectional study of 180 HIV/HCV co-infected patients who underwent liver biopsy between May 1998 and November 2001. A total of 126 patients with a known date of HCV infection were evaluated. Liver fibrosis was defined as a Knodell stage of fibrosis 1–4. The mean age was 36.7 (3.8) years, 81% were male and had a mean age of 20.5 (3.8) years at HCV infection. Mean CD4 cell count and plasma HIV-1 RNA load at the time of biopsy were 552 cell/mm³ (239) and 2.5 log₁₀ (0.9), respectively; 118 patients had been on antiretroviral therapy (ART) for a median of 45 months (Q1–Q3: 21–75) and 84 on protease inhibitor for a median of 12.0 months (Q1–Q3: 0–29.5); 55 had an AIDS event or a CD4 cell count nadir < 200 cells/mm³ prior to biopsy. Median histological activity index was 6 and 27% had a Knodell stage of fibrosis 0. On the multivariate analysis time on ART (OR for 6 months extra: 0.954, 95% CI: 0.859–0.994), CD4 cell count at the time of liver biopsy (OR for 100 cells/mL increase: 0.740, 95% CI: 0.670–0.905), age at HCV infection acquisition (OR for 5 years extra: 2.594, 95% CI: 1.326–5.133) and alcohol intake (> 50 g/day) (OR: 2.73, 95% CI: 1.108–6.731) were associated with liver fibrosis. Hence ART should be a priority in HIV/HCV co-infected patients eligible for anti-HCV treatment as it is a protective factor for liver fibrosis.     

The Adjunctive Use of Tricyclics in a Methadone Program

Abstract

The hepatitis-C virus (HCV) spreads rapidly among injection drug users (IDUs) because each act of sharing injection equipment carries a high risk of transmission. IDUs are hard to reach, especially in the early stages of their drug-using careers. IDUs are also poorly organized for self-help. For these three reasons, prevention campaigns that worked against the spread of HIV among gay men will be far less effective against the spread of HCV among IDUs. The best hope for such HCV prevention lies in (1) education of middle and high school youth on parenteral risks, and (2) normalization of needle exchange.     

Examining Drug Treatment Entry Patterns Among Young Injection Drug Users

Using a longitudinal state data base, 1996–2002, of all Injection Drug Users (IDU) (n = 37,227) admissions to all state-licensed drug treatment programs, this study examined differences in drug treatment entry patterns between younger IDUs (ages 18–25) compared to middle-age IDUs (ages 26–39) and older IDUs (over 40 years of age). Most of the younger IDUs were male, unemployed, and dependent on heroin. After controlling for factors known to affect type of drug treatment entered, younger IDUs were significantly more likely than their older counterparts to only use detoxification services and not enter additional treatment. Further, younger IDUs were significantly less likely to enter methadone maintenance and significantly more likely to enter residential treatment compared to older IDUs. Development of strategies to promote transition from detoxification to more comprehensive treatments and especially to methadone maintenance treatment is warranted.     

深圳部分吸毒人群HIV感染者HIV-1分子流行病学调查

目的对深圳市2008年吸毒人群进行HIV-1分子流行病学调查研究,了解本地区吸毒人群HIV-1流行情况、亚型种类、毒株来源、变异情况等,为预防和控制HIV在吸毒人群中的流行提供有价值的资料。方法收集深圳市2008年份吸毒人群HIV-1抗体阳性样本21例,应用巢式聚合酶链式反应（nested—PCR）技术,对该样本膜蛋白基因（env基因）和核心蛋白（gag基因）进行扩增,并对其各基因区核苷酸序列进行测定和分析。结果21例HIV-1阳性样本中共存在CRF01-AE 1种重组毒株以及A11种亚型,其在所有分析样本中的比例分别为90．5％和9．5％;其中12份Env基因样本中,10份为CRF01-AE重组亚型,与国际参考株01AE．TH．90．CM240最近,基因离散率为（9．910±2．432）％,组内离散率为（12．747±3．066）％;2份为A1亚型,与国际参考株a1．gu.92．92ug037最近,基因离散率为（17．15±0．354）％,组内基因离散率0．900％。21份Gag基因样本中,19份为CRF01-AE重组亚型,与国际参考株01AE．TH．90．CM240最近,基因离散率为（5．083±1．341）％,组内离散率为（6．072±1．968）％;2份A1亚型,与国际参考株01ae．en．97．97cngx2f最近,基因离散率为（11．550±0．636）％,组内离散率为2．200％。结论2008年深圳地区HIV-1抗体阳性吸毒人群中HIV-1流行株以CRF01-AE重组亚型为主,并首次在深圳地区吸毒人群中发现A1亚型。     

A meta-analysis of the hepatitis C virus distribution in diverse racial/ethnic drug injector groups

Hepatitis C virus (HCV) is mostly transmitted through blood-to-blood contact during injection drug use via shared contaminated syringes/needles or injection paraphernalia. This paper used meta-analytic methods to assess whether HCV prevalence and incidence varied across different racial/ethnic groups of injection drug users (IDUs) sampled internationally. The 29 prevalence and 11 incidence studies identified as part of the HCV Synthesis Project were categorized into subgroups based on similar racial/ethnic comparisons. The effect estimate used was the odds or risk ratio comparing HCV prevalence or incidence rates in racial/ethnic minority groups versus those of majority status. For prevalence studies, the clearest disparity in HCV status was observed in the Canadian and Australian Aboriginal versus White comparison, followed by the US non-White versus White categories. Overall, Hispanic IDUs had greater HCV prevalence, and HCV prevalence in African-Americans was not significantly greater than that of Whites in the US. Aboriginal groups showed higher HCV seroconversion rates when compared to others, and African-Americans had lower seroconversion rates compared to other IDUs in the US. The findings suggest that certain minority groups have elevated HCV rates in comparison to other IDUs, which may be a consequence of stigma, discrimination, different risk behaviors or decreased access to health care, services and preventive education. Future research should seek to explicitly explore and explain racial/ethnic variations in HCV prevalence and incidence, and define the groups more precisely to allow for more accurate detection of possible racial/ethnic differences in HCV rates.     

HIV prevalence among injection drug users in rural Guangxi China

AIMS: To determine the HIV-1 seroprevalence, risk behaviors and demographic characteristics associated with HIV-1 infection among injection drug users (IDU) in rural Guangxi, China. DESIGN AND SETTING: Between July and November 2002, 702 IDU were screened for HIV-1 antibody through community outreach in rural Guangxi, China for enrollment in an HIV sero-incidence study. PARTICIPANTS: A total of 702 active high-risk IDU were screened. High-risk injection was defined as anyone who reported injecting drugs at least three times per week in the last month or injected drugs with shared equipment on at least three occasions in the last 3 months. MEASUREMENTS: HIV-1 antibody testing with confirmation by Western blot was performed on all subjects. Demographic and risk assessment survey data were collected at screening from everyone whose baseline HIV antibody status was known. FINDINGS: HIV-1 antibody prevalence among 702 IDU at baseline was 25% with a median age of 26.7 years (18.2-43.2). Based on a multivariate logistic regression model using risk factors identified in univariate analyses, the following risk factors were associated significantly with an increase in risk for HIV seropositivity: age > 26 years (OR 1.50; 95% CI 1.04, 2.17), sharing of rinse water (OR = 1.24; 95% CI 1.09, 1.40), not having sex in the last 6 months (OR = 1.62; 95% CI 1.08, 2.43). CONCLUSIONS: HIV infection among IDU in Guangxi, one of China's major HIV epidemic regions, is high and the infection occurs predominantly among older IDU males who share rinse water.     

Attempted suicide among injecting and noninjecting cocaine users in Sydney,Australia

A sample of 183 current cocaine users, 120 primary injecting cocaine users (ICUs), and 63 primary noninjecting cocaine users (NICUs) were administered a structured interview to ascertain attempted suicide histories, methods used, and factors associated with suicide attempts. All respondents were volunteers and current cocaine users recruited through a wide range of sources. The mean age of participants was 30.1 years, and 65% were male. The ICUs were older (32.3 vs. 26.7 years, respectively), more likely to be male (72% vs. 54%, respectively), to be unemployed (84% vs. 23%, respectively) and to have a prison history (53% vs. 1%, respectively) compared to NICUs. Of the sample, 31% had attempted suicide, 18% had done so on more than one occasion, and 8% had made an attempt in the preceding 12 months. Overall, 28% of the sample had been treated by a medical practitioner after an attempt. ICUs (38%) were significantly more likely than NICUs (10%) to have attempted suicide and to have done so on more than one occasion (23% vs. 3%, respectively). The most common method used among both groups was self-poisoning (ICUs 28%, NICUs 8%), primarily by drug overdose. Violent methods had been used by 22% of ICUs and 3% of NICUs. Multivariate analyses revealed that injecting, female gender, and more extensive polydrug use were independent predictors of a suicide attempt. The prevalence of suicide in this study indicates that it represents a major clinical issue among ICUs and to a lesser extent among noninjectors of the drug. Those treating cocaine users for drug dependence need to be aware of the salience of suicide as a problem, among injectors in particular.     

Short- and long-term prognosis of infective endocarditis in non-injection drug users: improved results over 15 years (1987-2001)

INTRODUCTION AND OBJECTIVES: The treatment of infective endocarditis has undergone significant change within the last few years. The aim of this study was to evaluate the clinical features and prognosis of infective endocarditis over both the short and long term in patients who are not intravenous drug users. PATIENTS AND METHOD: We carried out a prospective study of 222 consecutive patients who were diagnosed with infective endocarditis between 1987 and June 2001 at two centers. RESULTS: Their mean age was 48 (19) years, with 145 (65%) being male. Overall, 154 (69%) had native valve endocarditis and 68 (31%) had prosthetic valve endocarditis. In 61 patients (27%), no predisposing heart disease was found. Staphylococci were the causal microorganisms in 37% of cases (81 patients), and streptococci, in 35% (78 patients). Some 48% of patients underwent surgery during the active disease phase. Overall, inpatient mortality was 17% (39 cases); a significant decrease had occurred in recent years, from 25% in 1989-1995 to 12% in 1996-2001 (P<.01). In addition, the percentage undergoing early elective surgery had increased between the two periods, from 22% to 32% (P<.05). During a follow-up of 60 (48) months, 15 patients (8%) needed late cardiac surgery and 18 (10% of the whole series) died. The 6-year survival rate was 72% overall, and 80% in those who survived the active disease phase. CONCLUSIONS: Short- and long-term prognoses for patients with infective endocarditis appear to have improved over recent years at our hospitals.