Estimating the size of the HIV epidemic among injecting drug users in Amsterdam

Aim of this study was to assess the cumulative incidence of HIV-infection, AIDS and pre-AIDS death in the population of injecting drug users (IDU) in Amsterdam. By assuming equivalence, between a cohort of IDU and the IDU population, of the ratios of incidences of AIDS and pre-AIDS death to the number of HIV positive persons giving rise to these incidences, the numbers of HIV positive persons and pre-AIDS deaths in the population could be calculated, given that other parameters were known. Cohort study data on HIV prevalence and incidences of HIV infection, AIDS, and pre-AIDS death, were combined with national AIDS surveillance data. As of 1 October 1994, the estimated cumulative number of HIV positive IDU in Amsterdam was approximately 1280, far higher than a recent back-calculation estimate. Of the 1280, 204 HIV positive IDU had been diagnosed with AIDS, while about 270 had died pre- AIDS. The HIV prevalence of IDU residing in Amsterdam that were still alive and free of AIDS was hence estimated at around 800. Since the incidence of pre-AIDS death and AIDS exceeded the number of seroconversions during the past four years, the HIV epidemic among IDU in Amsterdam appears to be dwindling. A lower bound of the number of HIV positive IDU being alive, AIDS-free and living elsewhere in the Netherlands was roughly estimated at 600. Because of untimely deaths, only a limited number of HIV positive IDU can be expected to be diagnosed with AIDS in the future. Since these estimates are based upon some rather bold assumptions, they should be interpreted with caution and require further validation by independent sources.     

我国预防控制经性途径传播艾滋病的政策变迁及趋势分析

我国艾滋病流行模式由早期静脉注射吸毒传播为主,逐渐演变为吸毒和性传播并重,进而发展到目前经性途径传播为主。中国20多年防控经性途径传播艾滋病的工作主要可分为四个阶段,在不同阶段,针对疫情,结合社会环境,采取了不同的防治策略,从早期的道德宣传和国境防范,到主动干预和积极预防,再到政府主导和全民动员,发展到目前防治形式的多样性和科学性,突破意识形态局限的阶段,反映了疫情、认识和策略之间的相互影响。在综合分析流行模式、防治策略、干预思想和预防技术的基础上,本文分析了未来预防控制经性途径传播艾滋病的策略,包括改进健康教育形式、创新干预手段、减少家庭内传播、更大限度发现HIV感染者、重视性别因素在扩大感染中的作用、关注流动人口的桥梁作用、消除社会歧视等。     

“一带一路”沿线国家HIV/AIDS流行现状及变化趋势研究

目的了解"一带一路"沿线国家HIV/AIDS的流行现状及变化趋势, 为防范HIV/AIDS跨境传播提供依据。方法选取与我国签署了共建"一带一路"合作文件的145个国家为本研究的"一带一路"沿线国家;145个国家2013-2019年HIV/AIDS年龄标化的发病率、患病率数据来源于2019年全球疾病负担研究。使用2019年年龄标化的发病率、患病率描述145个国家HIV/AIDS的流行现状。通过计算年估计百分比变化(EAPC), 分析HIV/AIDS发病率在2013-2019年的变化趋势。结果 2019年, 在非洲、亚洲、欧洲、北美洲、南美洲和大洋洲中, HIV/AIDS发病率≥40.00/10万的国家占比最高的地区是非洲, 为56.86%(29/51);最低的是亚洲, 为5.41%(2/37)。145个国家中, HIV/AIDS患病率≥100.00/万的国家多数位于非洲, 占20.69%(30/145)。2013-2019年, HIV/AIDS发病率呈上升趋势的国家共50个(34.48%, 50/145);呈下降趋势的国家共69个(47.59%, 69/145);无显著变化的国家共26个...     

Impact of the human immunodeficiency virus epidemic on mortality trends in young men, United States.

Following a long-term decline, death rates in men 25-44 years of age increased from 212 deaths/100,000 in 1983 to 236 deaths/100,000 in 1987. To assess the impact of human immunodeficiency virus (HIV) infections on this trend and to identify causes that are increasing in association with the HIV epidemic, we analyzed national mortality statistics and compared death rates in states with high and low incidence of acquired immunodeficiency syndrome (AIDS). In 1987, there were 10,248 deaths with HIV infection, AIDS, or conditions in the AIDS surveillance definition assigned as the underlying cause, representing 11 percent of deaths for men in this age group compared to less than 1 percent in 1980. In addition, deaths with other underlying causes, such as other infections, drug abuse, and unknown/unspecified causes, had diverging and higher rates in states with high versus low AIDS incidence. In the absence of deaths due to HIV/AIDS and excess deaths due to these associated conditions, we estimate that death rates for men 25-44 years of age would have been 201-209/100,000 in 1987. For 1987, approximately 70-90 percent of HIV-related deaths were reported through national AIDS surveillance. The HIV epidemic has led to a reversal in mortality trends and to increases in various causes of death for young men.     

Women and HIV

HEALTH ISSUE: The epidemic of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) in developed countries has changed from the early epidemic that affected primarily men who have sex with men, to one that increasingly affects other groups such as injecting drug users (IDU) and heterosexuals. As a result, the number and percentage of women with HIV and AIDS is increasing. KEY FINDINGS: The number of women in Canada living with HIV, including those with AIDS, has increased over time. An estimated 6,800 women were living with HIV at the end of 1999, an increase of 48.0 % from the 1996 estimate of 4,600. On an annual basis, women account for a growing proportion of positive HIV test reports among adults in Canada. This proportion increased from 10.7% in the period 1985-95 to 25% in 2001. Heterosexual contact is the main risk factor for HIV infection in women, accounting for 63% of newly diagnosed cases of HIV infection in adult Canadian women in 2001; the majority of the remainder is due to IDU. KEY DATA GAPS AND RECOMMENDATIONS: Research is needed to address specific information gaps regarding risk behaviours, testing patterns and HIV incidence and prevalence in women. This research needs to include the broader contextual factors that influence women's lives and their risk of HIV infection. Programmes and prevention efforts must be gender and age-specific and should target not only individual behaviours, but also the social and cultural context in which these behaviours occur.     

HIV/AIDS in eastern Europe: more than a sexual health crisis

HIV/AIDS is often described as a sexually transmitted disease. In the former USSR, however, the HIV/AIDS epidemic is being driven by injecting drug use among men. This article addresses several widely circulated assumptions about HIV in eastern Europe: that sexual contact is the primary mode of transmission, that women form a major increasing proportion of those infected, and that the disease threatens young people in particular. Because the rate of injecting drug use is extremely high in many eastern European countries, HIV control there cannot just target sexual transmission but must embrace other approaches, such as comprehensive harm reduction. In the area of treatment, scaling up access to highly active antiretroviral therapy has been a major global priority for the last two years. European efforts to broaden access have been generally quite successful, yet in the two European countries with the greatest need, the Russian Federation and Ukraine, the demand for treatment is growing much faster than its availability.     

Progress in the control of HIV infection and AIDS in Navarre, 1985-2003

The epidemiological situation of HIV infection and AIDS in Navarre in 2003 is reviewed. Up until December 2003, 1,610 HIV infections had been diagnosed in residents of Navarre, of whom 41% had died. The new diagnoses of HIV fell by some 81% between 1993 and 2003, a year in which 28 cases were diagnosed (4.8 per 100,000 inhabitants). The fall basically occurred in infections in injection drug users, since the cases due to sexual transmission had remained stable. Over half of the infections diagnosed in the period 2000-2003 (58%) were attributable to heterosexual transmission, 18% occurred in parenteral drug users and 12% in homosexual men. Thirty-three percent were persons originally from other countries. The incidence of AIDS fell from 75 cases in 1996 to 20 in 2003, and mortality from 65 to 8 cases, respectively. In the 2000-2003 period, the average annual incidence of AIDS was 4.2 per 100,000 inhabitants and the average annual rate of mortality was 1.6 per 100,000 inhabitants. At the end of 2003, there were 902 living persons with a diagnosis of HIV monitored by the health system (1.6 known infections per 1,000 inhabitants). In 2003, 65% of the youths aged between 15 and 29 referred to coital sexual relations, a higher percentage than in previous years, but their level of information on the prevention of AIDS was acceptable. It is necessary to insist on prevention and to adapt this to the new situation.     

Adult infection with hepatitis A despite declining endemicity; in favor of adult vaccination

Seropositivity against hepatitis A was examined among 4806 standing army personnel (4497 males and 309 females) during 1998-1999. Each bi-annual birth cohort examined showed a decline in seropositivity compared to the previous one. When compared with a study performed in 1989, however, for each of the 1961-1962, 1963-1964, 1965-1966, 1967-1968 and 1969-1970 birth cohorts examined, the 1998-1999 study showed 5-15% higher seropositivity. This trend remained after controlling for differences between the two studies in ethnic origin, sibship size and level of education. The overall seroconversion rate is estimated as 1.15% per year and the clinical to subclinical ratio as 1:14. Thus, hepatitis A infection continues to occur in the young adult age group and vaccination of this group should be considered.     

1990—2019年中国HIV/AIDS发病和死亡趋势及其年龄-时期-队列分析

目的 分析1990—2019年中国HIV/AIDS发病率和死亡率趋势及其年龄-时期-队列效应,为我国HIV/AIDS防治策略提供依据。方法 获取GBD 2019关于中国HIV/AIDS发病率和死亡率的数据,采用Joinpoint回归模型进行时间趋势分析,计算标化发病率和死亡率的年度变化百分比(APC)和平均年度变化百分比(AAPC)。运用年龄-时期-队列(APC)模型探讨影响中国HIV/AIDS发病率及死亡率风险的年龄效应、时期效应以及出生队列效应。结果 1990—2019年,中国HIV/AIDS男性疾病负担高于女性。标化发病率呈现先上升后下降的趋势(AAPC为3.28%),2006—2014年开始下降(APC为-8.46%),标化死亡率呈现上升趋势(AAPC为7.06%)。青壮年人群(15～19岁组至25～29岁组)和老年人群(65～69岁组至75～79岁组)发病率的年龄效应呈现上升趋势,男性最大RR为2.23,女性为1.84,65～69岁组(RR男性为1.23,女性为1.22)之前死亡率的年龄效应变化趋势男女一致,之后男性上升,女性下降。发病率时期效应先上升后下降,转折点为2004...     

Reconstruction of human immunodeficiency virus (HIV) sub-epidemics in Italian regions

BACKGROUND: The spread of human immunodeficiency virus (HIV) infections is likely to consist of sub-epidemics in local areas and/or risk groups. Small-area risk group specific analyses may thus be a suitable means of better understanding and controlling the epidemic course. METHODS: An age, period, and cohort back-calculation method was used to reconstruct region-specific epidemics of HIV infection. The HIV infection incidence rates were estimated for individual Italian regions by using as denominator the specific risk category population (i.e. intravenous drug user population [IDU], homosexual/ bisexual population [MSWM], and Italian general population for heterosexual contacts [HST]). Incidence rates obtained in this way represent the risk of HIV infection conditional to belonging to the specific sub-group of the population. RESULTS: The HIV epidemic is heterogeneous in terms of gender, risk category and region. The highest risk of HIV infection has been estimated in the Lombardia region (North-West area) among men belonging to the IDU category in 1985. In recent years, a trend of decrease in HIV has been estimated, especially among IDU and MSWM. For the HST category, some regions have shown trends of great increase, particularly on the island of Sardegna and the regions of Puglia and Sicilia (Southern Italy). In 1987, most HIV infections were observed among IDU (39-90%), while in 1992 the MSWM and HST categories made the greatest contribution to the HIV epidemic. CONCLUSIONS: The results stress the idea of sub-epidemics rather than a single epidemic affecting the entire country. Some Southern regions emerge as areas in which the spread of HIV infections, although still at a rather low level, should cause considerable concern, particularly the trend of new infections by heterosexual transmission involving the general population. Detailed information on levels and trends of HIV infection epidemics at the local level are essential for surveillance purposes and for planning health care facilities, and can highlight areas in which preventive measures can be effective.     

HIV/AIDS among men who have sex with men and inject drugs--United States, 1985-1998

Men who have sex with men and inject drugs (MSM/IDU) pose unique challenges for human immunodeficiency virus (HIV) risk reduction efforts because they have multiple risks for HIV acquisition and transmission. This report presents 1) the demographic characteristics of MSM/IDU diagnosed with acquired immunodeficiency syndrome (AIDS) in 1998 and MSM/IDU living with AIDS as of December 31, 1998; 2) trends in AIDS incidence among MSM/IDU from 1985 to 1998; and 3) information on selected behaviors from interviews of MSM/IDU who had AIDS diagnosed from 1996 to 1998 in 12 states. The findings indicate that 1) over half of MSM/IDU with AIDS were non-Hispanic blacks and Hispanics, and most MSM/IDU with AIDS were reported from large metropolitan statistical areas (MSAs); 2) AIDS incidence has declined since 1996; and 3) a high prevalence of drug-related and sexual risk behaviors occurred among MSM/IDU with AIDS.     

The AIDS epidemic among Spanish drug users: a birth cohort-associated phenomenon.

OBJECTIVES: In Spain the number of new acquired immunodeficiency syndrome (AIDS) cases among injection drug users continues to rise. The time trend up to 1994 has been analyzed, with special attention paid to the different generations. METHODS: The source for injection drug use-related cases was the Spanish AIDS Register. Independent analyses of annual specific rates were run for each sex with the use of an age-period-cohort log-linear model. RESULTS: After adjustment for age and year of diagnosis, AIDS incidence related to injection drug use is associated with specific birth cohorts. Rising values are observed in the successive generations born during the 1950s, peaking in men born in 1962 and women born in 1964. In subsequent cohorts, there is a marked falloff in incidence for both sexes, but this decline is seen to halt in men from the 1972 birth cohort onwards. The overall period effect is upward, yet the trend flattens in the last years. There is a pronounced age effect with maximum values in men and women at ages 29 and 27, respectively. CONCLUSIONS: It is essential to urge avoidance of risk behaviors in new generations.     

Geographical variation in disease progression in HIV-1 seroconverted injecting drug users in Europe?

BACKGROUND: Human immunodeficiency virus (HIV) disease progression might vary by geographical region due to differences in the spectrum of HIV-related illnesses and (access to) health care. Therefore, the effect of geographical region, next to the effect of other potential cofactors, on disease progression in 664 injecting drug users (IDU) with documented HIV seroconversion from eight cohorts in Europe was studied. METHODS: Kaplan-Meier methods and Cox proportional hazards analysis were performed to assess the effect of geographical region, other sociodemographics, drug use and repeated HIV exposure on progression from HIV seroconversion to immunosuppression, AIDS and death with AIDS. We considered the confounding effect of study-design related factors (e.g. setting of follow-up), and accounted for pre-AIDS death from natural causes by imputing when each endpoint would have occurred, had they not died without AIDS. RESULTS: Estimates of progression to AIDS and death with AIDS were substantially faster after taking pre-AIDS mortality into account. Median incubation time from seroconversion to the first CD4 count < 200 cells/microliter was 7.7 years (95% CI: 7.1-8.3) and to AIDS 10.4 years (95% CI: 9.8-infinity). The 10-year survival was 70.3% (95% CI: 62.8-76.6). The relative hazards (RH) of AIDS for IDU from central and southern Europe compared with IDU from northern Europe was 1.9 (95% CI: 1.2-3.0) and 1.2 (95% CI: 0.6-2.3), respectively, before, and 1.5 (95% CI: 0.7-3.2) and 1.1 (95% CI: 0.6-2.3) after taking differences in study-design related factors into account. Accounting for these factors, the RH of death with AIDS was 0.9 (95% CI: 0.3-2.5) for central and 1.2 (95% CI: 0.4-3.4) for southern Europe compared with northern Europe. For the first CD4 count < 200 cells/microliter these figures were 0.8 (95% CI: 0.5-1.4) and 0.8 (95% CI: 0.5-1.4). Age at seroconversion was the strongest predictor of disease progression. No statistically significant differences in disease progression were found by gender, foreign nationality, drug use and potential repeated HIV exposure. CONCLUSIONS: We found no evidence for regional variability in HIV disease progression among European IDU. Future studies evaluating geographical differences should consider the confounding effect of study-design related factors and differential non-AIDS mortality. As age is an important determinant of disease progression, it should be considered in recommending treatment.     

Behavior associated with HIV and HCV infection in female prison inmates in São Paulo, Brazil

An increase has been observed in AIDS and hepatitis C cases in women, including female prison inmates. This study focused on inmates' behavioral factors associated with risk of HIV and HCV transmission in a women's detention facility in S?o Paulo, Brazil. Behavioral questionnaires were applied and HIV and HCV serology were performed. The selected measure of association was odds ratio for both the bi and multivariate logistic regression analyses. 290 inmates participated in the study. HIV and HCV prevalence rates were 13.9% and 16.2%, respectively. Statistically significant associations were observed (p < 0.05) between HIV and the following variables: partner with AIDS OR = 6.9 (2.7-35.2); injection drug users (IDU) OR = 3.3 (1.6-14.7); regular partner OR = 3.7 (1.5-8.3), and between HCV and: IDU OR = 13.7 (4.4-42.7); IDU partner OR = 4.9 (1.9-12.2); previous arrest OR = 2.8 (1.2-6.5) adjusted for: partner with AIDS, IDU, IDU partner, drug user, and previous arrest. In conclusion, parenteral risk was associated with HIV and HCV infection and sexual risk with HIV. Appropriate and continuous preventive programs are recommended in the prison.     

云南省德宏州静脉注射毒品者HIV新发感染率及其危险因素研究

目的 了解云南省德宏州静脉注射毒品者(IDU)中HIV新发感染率及其危险因素.方法 2004年10月招募HIV检测阴性的245名IDU进入队列,启动IDU人群艾滋病流行病学队列研究,于2006年底进行第一次随访检测确定HIV发病率.自2007年1月起,不断纳入新发现的HIV阴性的IDU,扩大流行病学研究队列,并每半年进行一次有关毒品使用和性行为等暴露因素的随访调查,同时血清学检测确定HIV新发感染率.结果 截止2008年底,共招募入组760名IDU,至少随访1次者有540人,累积观察1153.6人年,新发现HIV感染者47人,HIV新发感染率为4.07/100人年,其中2004-2006年为4.45/100人年,2007年为4.50/100人年,2008年为2.54/100人年.随访期间,研究对象中IDU比例和HIV新发感染率均有显著下降.Cox比例风险回归模型多因素分析显示,景颇族[风险比(HR)=2.56,95%CI:1.06～6.19]和除傣族以外的其他少数民族(HR=3.26,95%CI:0.89～11.96)的HIV感染风险高于汉族;随访期间注射毒品但未共针者(HR=2.27,95%CI:0.98～5.25)以及有共针注射毒品行为者(HR=5.27,95%CI:2.25～12.34)的HIV感染风险高于随访期间没有注射毒品者.结论 云南省德宏州既往IDU人群中注射吸毒的比例和HIV新发感染率近4年来均呈现下降趋势.共用注射器吸毒仍是IDU人群HIV感染的最重要的危险因素,不同民族IDU的HIV感染风险不同.     

广东省1986～1999年艾滋病患者与艾滋病病毒感染者流行特征及趋势

目的：分析广东省艾滋病毒者与艾滋病毒感染者（HIV／AIDS）流行现状及影响因素,寻找控制措施,方法：分析全省的HIV常规、哨点、行为监测及实际实验室资料,结果：1996年底首次发现静脉吸毒者HIV阳性以来,HIV／AIDS报告数平均上升86．2％,静脉吸毒占的比例从1996年前的1．4％上升到1999年的91．0％,吸毒者61．3％为HIV－1C亚型,结论：HIV／AIDS疫情已进入快速增长期,静脉吸毒为主要传播途径;当前工作重点是预防HIV／AIDS从吸毒人群向吸以及一般人群传播,并开展行为监测和干预。     

潞西市1989-2008年艾滋病疫情分析与防制对策

目的分析历年来人类免疫缺陷病毒（HIV）感染者和艾滋病（AIDS）的监测检测情况及流行状况,为潞西市艾滋病防治工作提供依据。方法对1989-2008年潞西市艾滋病疫情数据、艾滋病疫情资料及HIV抗体监测情况进行分析。结果20年来共报告HIV/AIDS病例3336例（其中本地2333例）,现管理、干预1483例;静脉吸毒人群HIV感染者阳性率21.12%;商业性性工作者人群HIV阳性率4.70%;羁押人群HIV阳性率3.50%。结论加强对吸毒人员、商业性性工作者、羁押人员、外出务工人员等人群的干预和管理,做好HIV/AIDS的告知、随访等管理,认真做好溯源调查及自愿咨询检测（VCT）,提高阳性发现率,是控制艾滋病传播的重要措施。     

山东省艾滋病疫情与流动人口现状分析

[目的]分析山东省艾滋病疫情与流动人口现状,为制定艾滋病防控策略和措施提供依据。[方法]采用SPSS15.0统计软件描述性分析1992～2009年山东省艾滋病疫情报告数据及流动人口资料。[结果]1992～2009年全省报告的艾滋病病毒感染者和艾滋病病人中,户籍地为外省(籍)的病例占报告总数的55.6%。外来妇女、注射吸毒者和男男性行为接触者分别占报告总数的19.7%、17.8%和10.7%,外来妇女感染者的配偶和子女均发现阳性感染者。[结论]流动人口中艾滋病疫情不容忽视,必须采取措施加强流动人口的艾滋病防治。     

Prevalence of cigarette smoking among subsequent cohorts of Italian males and females

Prevalence of cigarette smoking among successive cohorts of Italian males and females born between 1890 and 1969 was estimated from data of the 1983 National Health Survey (based on 89,765 persons randomly selected within strata of geographical area, size of place of residence, and size of household), opportunely corrected for excess mortality of smokers. The overall participation rate for the original sample was 93.6%; impossibility of tracing or refusal of the interview led to substitution of 2,058 households. Among males, smoking prevalence in the young and middle-aged increased steadily up to the generation born in 1920-1929, which, in its 30s, showed the highest absolute smoking prevalence (68.3% in 1960). Moderate declines followed, chiefly on a calendar-period basis (i.e., between 1970 and 1980 in each birth cohort). These declines occurred later and at a lower rate than in several other Western countries. Among females, cigarette smoking was extremely rare for those generations born at the turn of the century (only about 3% of Italian females born in 1890-1899 ever smoked), but increased steadily in each birth cohort and calendar period to reach a rate only about one-third lower than that of males in the 1960-1969 cohort.     

衡阳市HIV/AIDS流行现状及趋势分析

目的了解和掌握衡阳市HIV感染和发病情况,为进一步开展艾滋病防制工作提供科学依据。方法对1992~2004年衡阳市艾滋病的常规监测、哨点监测和专项监测结果及流行病学个案调查等资料进行综合分析。结果1992~2004年共监测高危人群5 263人,发现HIV感染者486例,HIV阳性检出率为9.23%,其中45例发病,29例死亡。感染途径以血液传播为主,占84.77%,其中静脉吸毒占血液传播中99.51%,其次为性途径传播。感染者以青壮年男性为主,职业大多为无业,其次为农民。结论目前,衡阳市处于艾滋病流行快速增长期,HIV感染途径以静脉吸毒为主,性途径传播有上升趋势。因此,开展宣传教育、行为干预,提高高危人群和一般人群自我防范意识,对遏制艾滋病在全市传播和流行具有十分重要意义。