Altice Frederick L, Springer Sandra, Buitrago Marta, Hunt David P, Friedland Gerald H
Yale University AIDS Program, New Haven, Connecticut 06510, USA.
J Urban Health. 2003 Sep;80(3):416-27. doi: 10.1093/jurban/jtg053.
The introduction of highly active antiretroviral therapy (HAART) has resulted in marked reductions in mortality and acquired immunodeficiency syndrome (AIDS) incidence across all risk groups; however, the proportionate decrease among injecting drug users (IDUs) has been less impressive. Much of the disparity in benefit to IDUs has been a consequence of decreased access to and receipt of potent antiretroviral combinations. Strategies to increase access to and utilization of HAART have included entry into drug treatment and abstinence. Unfortunately, as few as 15%-20% of active drug users in the United States, and in many other countries, are in drug treatment at any one time. We report a pilot project among out-of-drug treatment IDUs infected with human immunodeficiency virus (HIV); HIV therapy was successfully provided to active heroin injectors using the Community Health Care Van (CHCV) at sites of needle exchange. Subjects were willing to initiate, but were not receiving, recommended HIV therapy and were not interested in formal drug treatment. Antiretroviral therapy regimens were selected and linked to heroin injection timing. Weekly visits were scheduled by CHCV staff to assess adverse side effects and encourage adherence. Of the 13 participants, the mean baseline HIV-1 RNA level and CD4 lymphocyte count were 162,369 (log 5.21) copies per milliliter and 265 cells per milliliter, respectively. By 6 months, the proportion whose HIV-1 RNA was below the limits of detection (<400 copies/mL) was 85% (N=11); 77% (N=10) had nondetectable levels by 9 months. By 12 months, 54% (N=7) had a persistently nondetectable viral load, and the net increase in CD4 lymphocyte count was 150 cells per milliliter. As an additional and unintended benefit of this pilot project, 9 (69%) subjects chose to enter drug treatment after achieving a nondetectable viral load. Entry into drug treatment was associated with durability of viral suppression. This small pilot study suggests that health services based on needle exchange may enhance access to HAART among out-of-treatment HIV-infected IDUs. In addition, it demonstrates that this population can benefit from this therapy with the support of a nontraditional, community-based health intervention.
高效抗逆转录病毒疗法（HAART）的引入已使所有风险群体的死亡率和获得性免疫缺陷综合征（AIDS）发病率显著降低；然而，注射吸毒者（IDU）中这一比例的下降却不那么显著。IDU受益程度存在差异，很大程度上是因为获得强效抗逆转录病毒联合疗法的机会减少以及接受该疗法的情况不佳。增加HAART可及性和利用率的策略包括进入药物治疗和戒毒。不幸的是，在美国以及许多其他国家，任何时候接受药物治疗的活跃吸毒者比例低至15% - 20%。我们报告了一项针对未接受药物治疗且感染人类免疫缺陷病毒（HIV）的IDU开展的试点项目；通过社区卫生保健车（CHCV）在针头交换点成功为活跃的海洛因注射者提供了HIV治疗。研究对象愿意开始但未接受推荐的HIV治疗，且对正规药物治疗不感兴趣。选择抗逆转录病毒治疗方案并与海洛因注射时间相关联。CHCV工作人员安排每周探访以评估不良副作用并鼓励坚持治疗。在13名参与者中，HIV - 1 RNA的平均基线水平和CD4淋巴细胞计数分别为每毫升162,369（log 5.21）拷贝和每毫升265个细胞。到6个月时，HIV - 1 RNA低于检测下限（<400拷贝/毫升）的比例为85%（N = 11）；到9个月时，77%（N = 10）的检测水平不可测。到12个月时，54%（N = 7）的病毒载量持续不可测，CD4淋巴细胞计数每毫升净增加150个细胞。作为该试点项目的一项额外且意外的益处，9名（69%）受试者在病毒载量不可测后选择进入药物治疗。进入药物治疗与病毒抑制的持久性相关。这项小型试点研究表明，基于针头交换的卫生服务可能会增加未接受治疗的HIV感染IDU获得HAART的机会。此外，它表明这一人群在非传统的社区卫生干预支持下可从这种治疗中受益。
